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ATTACHMENT VI

TEBPF Journal

TO: Central Accounts Payable Division, 30 Trinity Street, Hartford, CT 06106
 (1)AGENCY NO.   (2) BATCH NUMBER     (3) NO. OF DOC.     (4) BATCH AMOUNT
1155     80,000     1     300,000.00 
(5) SUBMITTED  BY (Agency Name)
 Dept. of Housing 
 (6) TELEPHONE NUMBER - BUSINESS OFFICE xl234
 (7) PAYEE  (8) PAYEE LIST (9) 
PURCHASE ORDER NUMBER
(10)
REQ. FOR RES.OF FUNDS OR TRAV. AUTH. NO.
(11) 
AMOUNT OF INVOICE
TAX-EXEMPT BOND PROCEEDS FUND Deposit         300,000.00

  

NO

CHECK

REQUIRED

CHECK THE APPROPRIATE BOX   check box TAPE  check box ONLINE   XX CENTRALLY
AGENCY CERTIFICATION
As a duly authorized agent of the above named agency, I do hereby certify that to the best of my knowledge the amount shown above equals the totals of the invoices and/or payments submitted herewith for payment and are valid claims against the state; no commission, bonus or reward has been promised or received or is expected on account thereof, by an official or employee of the State; and the expenditures are authorized and properly chargeable to appropriations as indicated.
   (13) AUTHORIZED SIGNATURE (agency head) (14) CONTACT PERSON (18) DATE
DISTRIBUTION: Original - Comptroller Part 2 - Agency

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