Rev 06/16
Louisiana State University
Office of Accounting Services
Accounts Payable & Travel
217 Thomas Boyd Hall
RECEIPT OF DECLINING BALANCE CARD AS527-A
Program Name _________________________________________________
Contact _______________________________ Phone _______________ Email ________________
Dates of Participation ____________ to ____________ Approved by _____________________________________ Date _____________
Program Project Gift Grant Cost Center _____________
Fund Function Additional Worktags
# LSU ID Participant Name Amt Received Signature
1
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5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22