Custodian Change Form
Department name
Type of Fund: Petty Cash Change Fund
Former Fund Custodian
Proposed Fund Custodian
Alternate Fund Custodian
Phone Location
Fund Custodian Date
Alternate Fund Custodian Date
Department Chair, Dean, or Director
Date
Submit this form to Finance and Administration, Stop 8219
For Accounting Services Only:
Finance & Administration Date
)XQG #
I understand that the need for and the amount of this fund will be reviewed at least annually; that
confirmation of the fund balance will be made at least annually (at fiscal year-end); and that I am to notify
the Office of Finance and Administration of any c hanges in the above information. I further understand
that I am personally responsible for this fund and for ensuring that it is properly accounted for and
maintained.
I hereby certify that the current custodian has counted the cash and cash items in my presence. The count total
represents all undeposited cash and cash items for which I will be responsible at the time of this count. The above cash
and cash items in the amount of $
have been transferred to me, the new fund custodian.
UBO
Date
