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Authorized Originator Signature Form

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					                      Authorized Originator Signature Form
                            School Year 2009-2010


To:     Mr. Alvaro Perez – Chief Financial Officer

From: _________________________________ (School/Department)

Subject: Designation of Authorized Originators (Administrators Only)

Date: _________________________________



The following is a list of the 2009-2010 school year primary and secondary authorized originator
approval signatures for the above named organization. I fully understand that unless at least one of the
listed signatures appears on documents submitted for processing, those documents will be returned
unprocessed to the representative campus/department for authorized originator approval signature.


NAME & TITLE (PRINT OR TYPE)                              SIGNATURE

1. _________________________________                     _______________________________

2. _________________________________                     _______________________________

3. _________________________________                     _______________________________

4. _________________________________                     ______________________________

5. _________________________________                     ______________________________

6. _________________________________                     ______________________________




_________________________________________                           ______________________
SIGNATURE OF PRINCIPAL/DEPARTMENT HEAD                                          DATE

				
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posted:3/22/2010
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