Fillable RS Provisional Funds Withdrawal Form (Ohio Department of Administrative Services OIT SDD)

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RS Provisional Funds Withdrawal Form (Ohio Department of Administrative Services OIT SDD)

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The RS Provisional Funds Withdrawal Form (Ohio Department of Administrative Services OIT SDD) form is 1 page long and contains:

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  • 8 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Ohio Department of Administrative Services OIT SDD

BROWSE OHIO DEPARTMENT OF ADMINISTRATIVE SERVICES OIT SDD (OH) FORMS

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CONTINGENCY FUND WITHDRAWAL FORM
Withdrawal date:
Amount:
Description and justification*:
*Justification should include a detailed explanation as to why the funds belong to the entity and documentation providing sufficient proof must be attached to this form.
Withdrawal from Account:
TOS Provisional Funds TCCA 600-424-600
I hereby certify that the withdrawal of these funds is for a proper and legitimate use.
Authorized Agency signature: Date:
Revenue Management Department Use
Approve:
Deny:
If deny, alternative:
Authorized signature: Date:
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RS Provisional Funds Withdrawal Form (Ohio Department of Administrative Services OIT SDD)

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Completed 21 July 2020

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