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Brccdf11022015 (Baton Rouge Community College)

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201 Community College Drive • Baton Rouge, Louisiana 70806 • mybrcc.edu
AUTHORIZATION FOR DISBURSEMENT
INSTRUCTIONS: Completed disbursement forms must be submitted to the BRCC Foundation: 2
nd
Floor, Mid City
Campus Governor’s Building. Please attach original invoices, receipts, and other required documentation.
DATE:
ACCOUNT NAME:
ACCOUNT #:
PAYEE/VENDOR NAME & ADDRESS:
SPECIAL INSTRUCTIONS
CONTACT NAME:
TELEPHONE #:
INVOICE #:
DESCRIPTION/PURPOSE
TOTAL AMOUNT:
I CERTIFY THE FOLLOWING: The above expenses incurred in accordance with the documented purposes of the fund charged
and serve to benefit authorized Baton Rouge Community College programs. None of the above expenses have been paid by any
other funding source.
______________________________________________________ __________________________
Supervisor/Dean/Vice Chancellor/Chancellor DATE
______________________________________________________ __________________________
BRCC Foundation DATE
TO BE COMPLETED BY FOUNDATION:
FOUNDATION CHECK #_________CHECK DATE:_________ RECEIVED BY:__________________________
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Brccdf11022015 (Baton Rouge Community College)

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Completed 23 July 2020

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