State of Connecticut ACCOUNTING PROCEDURES MANUAL - STUDENT ACTIVITY FUND - EXHIBIT L CHART OF ACCOUNTS
EXHIBIT L
New 8/98

CHECK REISSUE REQUEST FORM

Return or mail to:
 
Agency Name
Address
Address
Address
Name/Address __________________ Social Security or FEIN#____
__________________ Telephone # ___________
__________________

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I certify that the check issued for _____________________ in the amount of__________ has been lost or has not been received by me. I request a new check be issued to me at the above address. (I understand that, should I receive/locate the original check, I will return it to the (AGENCY)).

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______________________________
Signature

__________________
Date

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