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									                                                                                   Refund of Receipts/Sales Credit Form
Vendor #                                                                                           Cash Management, 21 N. Park Street, Suite 6101                                          Voucher #
                                                                                                                                                                                           Additional Information/Justification:
Check Payable To: (Customer or Other)                                                                                                 County Tax          Tax
                                                                      Amount(s)            Account    Fund        Dept       Prog.                                              Project
(last name, first name, initial)                                                                                                      Code Name          Code                              Provide description of why money is being refunded

Send Check to (requires a mailing address):                                                 9224
Address 1:                                                                                  9220

Address 2:                                                                                                                     R
City:                                                                                       9220

State:    Zip/Postal Code:       Country:                                                                                      R
Refund Reference:                Payment Handling Code:                                     9220

                                                                                        TOTAL AMOUNT
Contact Information:               Date:
Name:                                                            E-mail:                                                             Telephone Number:
                              Please see the following website for Refund of Receipts/Sales Credit Form Instructions and Guidelines:
I certify that I have reviewed this refund payment and find it to be in compliance with all established purchasing and accounting policies.

Supervisor Approval                                                                                                           E-mail address                                          Telephone Number                             Date

Dean/Director Approval                                                              Date                                                      Authorized Institution Approval                                                      Date
                                            Attach original refund of receipts/sales credit form and supporting documentation and send to your Dean/Director's Business Office for review and approval
                                                                                          before sending to Cash Management, Suite 6101, 21 N. Park Street.

               Last updated 1/20/2011.                                                                                                                                                      4e064e2b-5400-4ad6-906e-d503a57ebe82.xls

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