8.8 Contract Pmt Form 0606

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8.8 Contract Pmt Form 0606 Powered By Docstoc
					                                 Georgia Department of Human Resources
                                                    Contract Payment Form
                    Contract #                           Payment for the month of                             Payment Amount


                  Program Name                                 Vendor Name                                    Vendor Number


                 Advance Balance                             Reclaim Amount                       End Advance Balance


       Invoice #                    Invoice Date             Handling Code           Acctg. Template           Check              EFT


                                 Approval Signature                                        Date Approved                Telephone #



        Instructions                                         PO Line #           PO Line #           PO Line #             PO Line #
                                 Total (All PO Lines)
Contract (Amend______)

Total Contract

Tot Pymnts Prior Months

Dollar Value This Pymnt

Certified Cost

Balance of Contract

  PO Line              Department         OPB Sub Program        Project       Fund Source                 Amount          PO Line Total


  PO Line              Department         OPB Sub Program        Project       Fund Source                 Amount          PO Line Total


  PO Line              Department         OPB Sub Program        Project       Fund Source                 Amount          PO Line Total


  PO Line              Department         OPB Sub Program        Project       Fund Source                 Amount          PO Line Total


  PO Line              Department         OPB Sub Program        Project       Fund Source                 Amount          PO Line Total


  PO Line              Department         OPB Sub Program        Project       Fund Source                 Amount          PO Line Total


  PO Line              Department         OPB Sub Program        Project       Fund Source                 Amount          PO Line Total


  PO Line              Department         OPB Sub Program        Project       Fund Source                 Amount          PO Line Total


  PO Line              Department         OPB Sub Program        Project       Fund Source                 Amount          PO Line Total


  PO Line              Department         OPB Sub Program        Project       Fund Source                 Amount          PO Line Total



                                           The next lines are for Office of Financial Services use only.
         Voucher #                                              OFS Signature                                              Date




        Revised 06/06

				
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