Page
Of
Department Name: Date
Item Description
GL Bus. Unit
Account Org. Dept.
Fund Category Fund Function* Project* Program*
Purpose* Site* Amount
* Indicates field is conditional and may not apply to every transaction. TOTAL
Coins
$100.00 $1.00
$50.00 $0.50
$20.00 $0.25
$10.00 $0.10 Amount
$5.00 $0.05
Cash**
$2.00 $0.01
Checks**
$1.00
Total Grand Total
Total:
Received By (not processed)
Phone Ext Signature Date Received
Verified By (PRINT) Phone Ext Signature Date Processed
Cashier
Distribution: Cashier's will keep this copy.
Bring extras for departmental records if needed. Receipt #
**10-KEY TAPE OR SPREADSHEET LISTING OF CASH AND CHECKS MUST BE ATTACHED
Currency (by dollar amount)
Deposit Form
Prepared By (PRINT)
Enter# of
checks below
Please provide a contact phone number below ( Phone Ext. ) for any questions the Cashier's Office may have regarding this deposit.
Cashier Use ONLY
By signing below, I certify that the above deposit has been examined and verified.
$ 0.00
$ 0.00
$ 0.00
$ 0.00
click to sign
signature
click to edit
click to sign
signature
click to edit
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