Fillable OFFICE OF THE ILLINOIS STATE TREASURER REGISTERING AGENCY (Illinois State Treasurer's Office)

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OFFICE OF THE ILLINOIS STATE TREASURER REGISTERING AGENCY (Illinois State Treasurer's Office)

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Mail Form and Check To: Office of the Illinois State Treasurer
Attn: Fiscal Operations
P.O. Box 10254
Springfield, IL 62791-0254
Make Checks Payable To: Treasurer of the State of Illinois
Name of Fund Check Number Check Amount
Sex Offender Management Board Fund
OFFICE OF THE ILLINOIS STATE TREASURER
REGISTERING AGENCY REMITTANCE FORM
Name of Registering Agency Today's Date
Contact Name Contact Phone Number
Contact Jamie Usherwood at 217-558-2987 with any questions.
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OFFICE OF THE ILLINOIS STATE TREASURER REGISTERING AGENCY (Illinois State Treasurer's Office)

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Completed 13 August 2020

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