Louisiana State University
Office of Accounting Services
Bursar Operations
125 Thomas Boyd Hall
ACKNOWLEDGEMENT OF CASH INCENTIVE PAYMENT AS549
Name of Workshop/Research Study _______________________________________________________________________
Account # _______________________________ Contact/Principal Investigator (PI) ______________________________________________ Phone __________________
Dates of Participation __________________ to __________________ Approved by __________________________________________________ Date _________________
LSUID Name Address City/State/Zip * Amt Received Signature
* Payments to nonresident aliens must comply with the procedures set forth in FASOP: AS-04
Rev 07/07
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