Form 14311 - Report Of Collections / Receipts (Due Treasurer Of State)
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1REPORT OF COLLECTIONS / RECEIPTS
FOR TREASURER USE ONLY
(DUE TREASURER OF STATE)
State Form 14311 (R2 / 12-02)
Approved by State Board of Accounts, 2002
Approved by Auditor of State, 2002
LINE
FUND NUMBER
OBJECT
AMOUNT
CENTER
DESCRIPTION
NUMBER
GRAND TOTAL
Currency
Silver
Checks
Prepared by:
Deposits
Wire Transfers
Lock Box
Date prepared:
Preparer’s telephone number
Debts
Credits
ACH
TOTAL
I certify that this report is true and correct to the best of my knowledge
and belief.
Signatue of agency official or designee
Title
Name of state agency
Agency number
DISTRIBUTION: White - Auditor of State; Canary - Agency after processing; Pink - Treasurer
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Parent category: Business