UW-WHITEWATER STUDENT/FACULTY DEPOSIT FORM
ACCOUNT #: DATE:
ORGANIZATION:
DESCRIPTION
(Please identify the source of these funds.
Example: Fundraiser, Ticket Sales, Walworth Jefferson
Donations, Shirts Sales, Etc.) Total StateTax County Tax County Tax Taxable Net
TAXABLE Deposits Amount (5.0%) (.5%) (.5%) Deposit
Walworth County
- - $ -
- - $ -
Jefferson County
- - $ -
- - $ -
Taxable Deposit Total $ - $ - $ - $ - $ -
Total
NON-TAXABLE Deposits Itemize Checks Here
Amount
Description Check Amount
1.
2.
Non-Taxable Deposit Total $ - 3.
4.
Deposit Summary 5.
6.
Taxable Net Deposit - 7.
Non-Taxable Deposit - 8.
9.
Net Deposit Total $ - 10.
11.
12.
Currency $ - 13.
14.
Coin $ - 15.
16.
Checks* $ - 17.
18.
Subtotal - 19.
- State Tax - 20.
- County Tax -
Total Deposit $ - Total Checks $ -
(Should equal Net Deposit Total)
SIGNATURE
*Please endorse all checks properly (Required)
*Please list all checks separately on the right of this form