VSCC STOP PAYMENT FORM
If you wish to have the check described below reissued, please complete the bottom
portion of this form. Please have it notarized by a Notary Public and return to:
Volunteer State Community College
Business Office - Donna Davis
1480 Nashville Pike
Gallatin, Tennessee 37066
Your check will be reissued as soon as possible.
To Whom It May Concern:
This is to certify that I did not cash nor receive any proceeds from the check identified
below. Further, I did not authorize anyone else to cash this check.
**************Signature must be witnessed by a Notary Public***************
Subscribed and sworn before me this _____________day of ______________,20_____
Notary Public__________________________________________
My commission expires _________________________________
Date
Check Number Check Date
Payable To:
Amount:
Vendor Number:
Other Information
Printed Name Signature
Address:
City, State, Zip Code
