CONTINGENCY FUND DEPOSIT FORM
Receipt date:
Amount:
* Description must include payee, bank name, bank account number funds were drawn on, how the funds arrived at TOS (i.e.; through the mail). Documentation attached.
Deposit to Account:
TOS Provisional Funds TCCA 600-424-600
State Regular (GRF)
Deposit Date:
Authorized Agency signature: Date:
Revenue Management Department Use
Approve:
Deny:
If deny, alternative:
Authorized signature: Date:
Description*:
EMAIL
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signature
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