Form 0501RCCD-004 "ACH (Direct Deposit) Payment Form" - Nevada

What Is Form 0501RCCD-004?

This is a legal form that was released by the Nevada Department of Public Safety - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2019;
  • The latest edition provided by the Nevada Department of Public Safety;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 0501RCCD-004 by clicking the link below or browse more documents and templates provided by the Nevada Department of Public Safety.

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Download Form 0501RCCD-004 "ACH (Direct Deposit) Payment Form" - Nevada

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Records, Communications and Compliance Division
333 West Nye Lane, Suite 100
Carson City, Nevada 89706
Telephone (775) 684-6262 ~ Fax (775) 687-3232
www.rccd.nv.gov
When submitting an ACH (Direct Deposit) payment to the Nevada State Treasurer’s Office please
ACH Direct Deposit (Payment) Processing Notice
fax or email the following information to our Accounts Receivable unit so that we may notify the
Treasurer’s office of the incoming funds. This is necessary in order to ensure all funds are received
by the proper agency and applied to the proper accounts.
Account Name:
Brady
CNC
Civil Applicant
Contact Name:
Telephone Number:
Ext.
Fax Number:
E-mail Address:
Total Payment Amount:
Date of Transfer:
Account Number
Invoice Number
Payment Amount
Comments
Account Holder Signature
Account Holder Printed Name
Date
0501RCCD-004(06/2019rev)
Records, Communications and Compliance Division
333 West Nye Lane, Suite 100
Carson City, Nevada 89706
Telephone (775) 684-6262 ~ Fax (775) 687-3232
www.rccd.nv.gov
When submitting an ACH (Direct Deposit) payment to the Nevada State Treasurer’s Office please
ACH Direct Deposit (Payment) Processing Notice
fax or email the following information to our Accounts Receivable unit so that we may notify the
Treasurer’s office of the incoming funds. This is necessary in order to ensure all funds are received
by the proper agency and applied to the proper accounts.
Account Name:
Brady
CNC
Civil Applicant
Contact Name:
Telephone Number:
Ext.
Fax Number:
E-mail Address:
Total Payment Amount:
Date of Transfer:
Account Number
Invoice Number
Payment Amount
Comments
Account Holder Signature
Account Holder Printed Name
Date
0501RCCD-004(06/2019rev)