Cash Paid Out
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Today's Date: ____/____/______
Date Cash Needed: ____/____/______
Event Date: ____/____/______
Department Name:
________________________________
Event:
________________________________
Event Location:
________________________________
Person Requesting the Cash Paid Out:
________________________________
Phone Number:
________________________________
Total Cash Paid Out $
________________________________
Preferred Denominations:
________________________________
Expense Code:
________________________________
Purpose of Cash Paid Out:
________________________________
________________________________
I understand that I the undersigned am responsible for the return of receipts and / or cash in the full amount as stated above.
I hereby authorize ________________ to pick up my Cash Paid Out at Treasury.
Responsible Party:
________________________________
Signature:
________________________________
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