Date
Account Name Amount
Account Name Amount
( must be equal to Transfer From: Total)
Signature Date
Signature Date
Signature Date
Signature Date
Signature Date
Signature Date
Account Number
Account Number
Transfer From:
Transfer To:
Student Club Treasurer/Representative
(print name)
Organization Representative
(print name)
Associated Students Controller/Treasurer
(print name)
Coordinator, Student Activites
(print name)
Dean Student Life, VP Student Services, or VP Academic
Affairs (academic trust accounts only )
(print name)
DepartmentPreparer's Name
ACCOUNT TRANSFERS
Transfer To: Total
Fiscal Year 20____
Club Advisor/Organization Advisor
(print name)
Transfer From: Total
Riv MV Nor Dist
Rev. 01/19
$ 0
$ 0
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