Fillable 2011 Expense Payment Form printable pdf download

2011 Expense Payment Form

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EXPENSE PAYMENT FORM

Instructions

Use this form when requesting that PENSCO pay an expense with funds from your PENSCO account. Please include

supporting documents (e.g. bill, invoice, etc.) when submitting this form to PENSCO.

1. PENSCO Account and Investment Information

Account #: _______________________________________________________________________________________________________

Accountholder’s First Name: ______________________________ MI: _____ Last Name: _____________________________________

Primary Phone #: (________) _________ - ________________

Name of Investment:_______________________________________________________________________________________________

(e.g., name of asset if LLC, LP or C-Corp, property description of real estate, or borrower’s name if a note)

Percent of Ownership ___________ %

2. Payment Information

Any request over $5,000.00 requires a breakdown of what the funds will be used for.

If the payment requested is to a property manager, they must be listed on the account prior to a payment being

processed.

Amount: $_______________

Expense payment due date: ______________________________________________________

Purpose of payment:_____________________________________________________________________________________

(e.g., “tax payment,” “insurance payment,” “HOA fees”)

Memo/reference:________________________________________________________________________________________

(escrow #, account #, etc.)

Payee’s name:__________________________________________________________________________________________

(i.e., to whom you want PENSCO to make the payment.)

Address: ______________________________________________________________________________________________

(This must be a physical address if you want PENSCO to overnight a check and/or any signed documents)

City: _________________________________________________ State:_________ Postal Code: ___________ - __________

3. Capital Improvement Information (Complete this section if the payment you are authorizing is for a capital improvement

that will increase the value of the asset in your PENSCO account.

Capital Improvement

Yes

Capital Improvement payment represents as increase in value of $ __________________________________________________ to

(insert description of asset) ________________________________________________________________________________________

If the increase in value exceeds $25,000 or represents an increase in the value to the asset of more than 20%, you must

provide supporting documentation regarding the change in value (e.g., market comp., appraisal, etc.)

1 of 2

Confidential once completed.

Expense Payment Form IRA-5201 (11/06/12)

2011 Expense Payment Form

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