Get documents about "Receivables Annual Report F-80900
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DEPARTMENT OF HEALTH SERVICES STATE OF WISCONSIN
Division of Enterprise Services Page 1 0f 2
F-80900 (07/08)
RECEIVABLES ANNUAL REPORT
Name-Reporting Reporting Period - Indicate State Fiscal Year Covered: July 1, through June 30,
Organization (Strict June 30 cut-off date)
Description of
Receivables
Fiscal Year 7/1/ Current SFY Current SFY Current SFY Current SFY 6/30/
of Beginning + - - Accounts + or - = Ending
Origin Balance Charges Collections Written Off Adjustments Balance
Greater than 6 years $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
5 to 6 Years $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
4 to 5 Years $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
3 to 4 Years $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
2 to 3 Years $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
1 to 2 Years $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Current SFY $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
TOTAL $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Prepared By: Date Prepared
Reviewed By: Date Reviewed Amount of Deposits July 1 through the July cut-off date (deposits for first month of
subsequent fiscal year)
F-80900 (07/08) Page 2 of 2
RECEIVABLES ANNUAL REPORT
Name-Reporting Reporting Period - Indicate State Fiscal Year Covered: July 1, through June 30,
Organization (Strict June 30 cut-off date)
Description of
Receivables
Accounts Receivable Certification
I certify that all accounts receivable balances on the attached Reports of
Receivables are true and correct to the best of my knowledge. All FMS
accounts receivable balances have been reconciled to FMS accounts, and any
adjusting entries have been made. If receivables are not recorded on FMS,
please indicate the reason below:
Signature
Title
Date Certified
