Personal Withdrawal Request Page 19
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25TENNESSEE DEPARTMENT OF CORRECTION
Trust Fund Organization Account
Add/Change/Inactive Form
Date of Request:
Institution:
Name of Requester:
ADD NEW ORG
Suggested Name for ORG:
Purpose of ORG (How account will be used):
ORG will be Cleared: (Choose one)
1.
Monthly (or other Frequency)
2.
When Balance Exceeds
3.
Upon Completion of Program
4.
Never (Funds will be used for Operation of Inmate Organization)
5.
Other (Specify)
Is this account for an Inmate Club or Organization?
Yes
No
If “Yes”, please provide the name of the Staff Sponsor
Name of Staff Sponsor:
RACF ID:
ORG NAME CHANGE
Existing ORG#:
Reason for change:
INACTIVE ORG #
Reason for inactivity:
Fiscal Director Approval
Date
CR-3998
Duplicate as Needed
RDA 1198
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Parent category: Legal