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[{"$nulls":7},"PAYMENT REQUEST # "]
[{"$nulls":8},"(DEPTID PLUS 4 DIGIT UNIQUE #)"]
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["TYPE OF PAYMENT",null,null,"BUDGET YEAR","DATE CHECK REQ'D","VENDOR NO.","VOUCHER NO.",null,"CHECK NO./DATE"]
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["MAKE CHECK PAYABLE TO",{"$nulls":4},"TAX ID# / SOCIAL SECURITY #",null,null,1099]
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["MAILING ADDRESS (MUST BE FILLED OUT)",{"$nulls":4},"APT #.",null,null,"SPEEDTYPE"]
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["CITY",null,null,"STATE","ZIP CODE"]
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["TELEPHONE NO.",null,null,"FAX NO."]
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[null,"INV. DATE","INVOICE NO. / DESCRIPTION OF CHARGE","ACCOUNT","FUND","DEPT. ID","PROGRAM","ACTIVITY","CLASS","PROJ/GRANT","AMOUNT"]
["CHARGES"]
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["CREDITS"]
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["COMMENT (PRINTED ON CHECK - IF DESIRED) (25 CHARACTERS)"]
[{"$nulls":8},"TOTAL PAYMENT",null,0]
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[{"$nulls":6},"SPECIAL INSTRUCTIONS"]
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["PREPARED BY",null,null,"DEPT","EXT","DATE"]
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["APPROVAL SIGNATURE"]
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["PRINTED NAME",null,null,"DEPT","EXT","DATE"]
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["ACCOUNTING USE ONLY",null,null,"CASHIER'S USE ONLY",null,null,"ACCOUNTS PAYABLE USE ONLY"]
["ACCOUNTING APPROVAL BY",null,null,"RECEIVED BY",null,null,"DATE P/R RECEIVED"]
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["DATE",null,null,"AMOUNT PAID OUT",null,"DATE","DATE PAYMENT DUE",null,"DATE ENTERED BY"]
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["ACCOUNTS PAYABLE COPY (PLEASE MAKE COPY FOR YOUR RECORDS)"]