WITHDRAWAL REQUEST FORM
ARKANSAS STATE TREASURY MONEY MANAGEMENT TRUST
Please complete this form and return to the Arkansas State Treasury’s Office via email.
Email: MMTrust@artreasury.gov
Contact: STMMT Administrator (501-682-1291)
Participant Name:
Request Date: ____________________ Transaction Date:
Participant's Phone Number:
Participant’s Email:
Withdrawal Amount:
From STMMT Account Number:
To Bank Name:
Bank Routing Number:
Bank Account Number:
Authorized by:
______________________________________ ______________________________________
Signature Title
______________________________________ ______________________________________
Please Print Name Date
__________________________________________________________________
FOR TRUST USE ONLY
Ticket #___________
Correspondent
Bank Name__________________________________________________________
Bank T/R #_________________________ Account Balance__________________
Correspondent Bank T/R#_______________________________________________
