Cash Paid Out printable pdf download

Cash Paid Out

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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Cash Paid Out