Appendix D. CHECK REQUEST

Latest version.

CITY OF SOMERTON
Form Number 105
(Rev. 03/93)
CHECK REQUEST
Payable To

ACCOUNT
EXPLANATION
AMOUNT
TOTAL AMOUNT OF REQUEST
$
REQUESTED BY: DATE:
APPROVED BY DATE / /
APPROVED BY DATE / /
PREPARED BY DATE / /
CHECK NUMBER:
(Res. 2008-011, passed 2-19-2008)

                    
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