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Cash Receipt Template 1


Cash Receipt Template 1
Cash Receipt Template 1
Form GA-082a Rev 04/07/00
North Carolina State University
Cash Receipt Certification
Certification of receipt of cash from NC State University in connection with
(1) I certify that I received cash in the amount of $ for
Signature Address
(2) I certify that I received cash in the amount of $ for
Signature Address
(3) I certify that I received cash in the amount of $ for
Signature Address
(4) I certify that I received cash in the amount of $ for
Signature Address
(5) I certify that I received cash in the amount of $ for
Signature Address
I hereby certify that I have disbursed the stated amounts and have reviewed proper identification of each
individual listed above:
(Signature of Custodian)
Date
Cash Receipt Template 1