Form Wolfs-103 - Payment Voucher
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1
2IF YOU HAVE QUESTIONS ABOUT THIS FORM, CONTACT LARRY BUCHHOLTZ AT X5230
STATE OF WYOMING
WOLFS-103
APPROVAL:
PAYMENT VOUCHER
REV. 12/00
DOCUMENT APPROVAL
INVOICE ATTACHED
SCREEN APPROVAL
Instructions:
Use for invoices from ONE vendor.
DATE APPROVED
1. Each invoice must have at least one coding line.
However, an invoice may have multiple coding lines.
2. Group all invoices together and attach to this form.
3. Complete the information requested below.
MM
DD
YY
DATE:
TRAN
AGENCY
ID NUMBER
BATCH ID:
DOCUMENT ID
P 1 F
BFY:
VENDOR NUMBER
VENDOR NAME:
TOTAL AMOUNT:
AGENCY AUTHORIZED USE ONLY
LN
REFERENCE
SUB
NO CD AGY
NUMBER
LN
CLN
VENDOR INVOICE
FND
AGY
ORG
APPR UNIT
FUNC
OBJ/REV
OBJ
B/S ACCT
01
REPT
PROJECT NO.
CATG
DESCRIPTION
AMOUNT
LN
REFERENCE
SUB
NO CD AGY
NUMBER
LN
CLN
VENDOR INVOICE
FND
AGY
ORG
APPR UNIT
FUNC
OBJ/REV
OBJ
B/S ACCT
02
REPT
PROJECT NO.
CATG
DESCRIPTION
AMOUNT
LN
REFERENCE
SUB
NO CD AGY
NUMBER
LN
CLN
VENDOR INVOICE
FND
AGY
ORG
APPR UNIT
FUNC
OBJ/REV
OBJ
B/S ACCT
03
REPT
PROJECT NO.
CATG
DESCRIPTION
AMOUNT
LN
REFERENCE
SUB
NO
CD AGY
NUMBER
LN
CLN
VENDOR INVOICE
FND
AGY
ORG
APPR UNIT
FUNC
OBJ/REV
OBJ
B/S ACCT
04
REPT
PROJECT NO.
CATG
DESCRIPTION
AMOUNT
CLAIMANT SIGNATURE BLOCK, LEAVE BLANK UNLESS THIS FORM IS BEING USED FOR EMPLOYEE
REIMURSEMENT, THEN EMLOYEE MUST COMPLETE
CLAIMANT CERTIFICATION
I certify, under penalty of perjury, that this voucher and the items
included herein for payment are correct and just in all respects
DATED:
20
Signature of Claimant in Ink
CONTINUATION CODING SHEET
PAYMENT VOUCHER AGENCY APPROVAL
WOLFS-112 ATTACHED
I certify, under penalty of perjury, that this voucher and the items
included herein for payment have been delivered, or services performed as
AGENCY OPTIONAL USE
stated and the payment voucher is approved for payment.
By:
Approval #1
REQUIRED
Date
Approval #2
By:
Approval #3
REQUIRED
Date
Date Accepted
By:
OPTIONAL
Date
PRINT IN 4 COPIES, ORIGINAL TO SAO/AGENCY, 1 COPY TO AGENCY, 1 COPY TO VENDOR, 1 COPY TO DIVISIO
Press CTRL+SHIFT+P to automatically print 4 copies
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Parent category: Financial