Controller's Office ~
Stop Payment placed by: ________________________________________________ Date: ______________________
Void placed by: _______________________________________________________ Date: ______________________
STOP PAYMENT / VOID CHECK REQUEST
Submit to ADM 514 for processing
VENDOR
NAME: ___________________________________________________________
CHECK #_______
_______________ DATE ISSUED: ____________________
AMOUNT:
$__________________________
Attach check if available
VOID & DO NOT REISSUE CHECK
VOID & REISSUE CHECK (allow 5-7 days to issue a new check)
EXPLANAT
ION:
(Attach email or other supporting documentation)
REQUESTED BY: _______________________________ DATE: ____________
SIGNATURE
: ________________________________________
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