Form A-12 - Payment Voucher - Rhode Island And Providence Plantations
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1State of Rhode Island and Providence Plantations
Form A-12
VOUCHER
NO.
(8/00)
PAYMENT VOUCHER
VOUCHER DATE
BILL TO
PURCHASE ORDER
SHIP TO
REQUISITION NO.
FEIN/SSN
Vendor's
Name
and
Address
DESCRIPTION
TOTAL
0.00
VENDOR INVOICE
INVOICE DATE
INVOICE AMT.
DATE RECEIVED
ACCOUNT
BOC
COST CENTER
TOTAL AMOUNT
ENCUMBRANCE LIQUIDATED
I hereby certify that the items listed above have been received in good condition and accepted by me.
Preaudit
Approved By
Date
Data Entry
Authorized Agent
Date
DEPARTMENT
REMITTANCE
CONTROLLER
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Parent category: Legal