Accounts Receivable Return Deposit Item Processing Form
200 Piedmont Avenue, Suite 1604 West Tower, Atlanta, GA 30334 Phone (404) 656-2133, Fax (404) 463-5089
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Requesting Agency Name:
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Agency PeopleSoft Business Unit:
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Date Requested:
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Requested by:
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Phone Number:
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Requestor's Email Address:
TRANSACTION INFORMATION
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Statement Code:
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Statement ID:
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Transaction Amount:
Bank Date:
Brief Description of Reconciling Entry:
Authorized Approver
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By selecting this box, I certify I am authorized approver, on behalf of my agency, to submit this Accounts Receivable Return Deposit Item Processing Form to the State Accounting Office. I further acknowledge the voucher information entered is true in nature.
State Accounting Office Use Only
Processed By SAO:
Date:
Issue Number:
SAO Form: 100-D
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Indicates Response Required