GSA Form SF-1147 "Request for Issuance of Replacement Check Due to Error in Name and/Or Designation of Payee"

What Is GSA Form SF-1147?

This is a legal form that was released by the U.S. General Services Administration on May 1, 1995 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 1995;
  • The latest available edition released by the U.S. General Services Administration;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;

Download a fillable version of GSA Form SF-1147 by clicking the link below or browse more documents and templates provided by the U.S. General Services Administration.

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Download GSA Form SF-1147 "Request for Issuance of Replacement Check Due to Error in Name and/Or Designation of Payee"

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REQUEST FOR ISSUANCE OF REPLACEMENT CHECK DUE TO ERROR IN NAME AND/OR DESIGNATION OF PAYEE
To Disbursing Office
Date
CHECK NO.
DATE
AMOUNT
SYMBOL NO.
VOUCHER NO.
NAME AND/OR DESIGNATION ON CHECK:
I certify that the correct name and/or
CORRECT NAME AND/OR DESIGNATION:
ADMINISTRATIVE OFFICE
designation of the payee is as shown
hereon and the amount stated is due the
LOCATION
payee. Issuance of a replacement check as
indicated, for delivery in the usual manner,
is authorized.
SIGNATURE OF AUTHORIZED
CERTIFYING OFFICER
Replacement check issued as authorized
Standard Form 1147
Rev. 5/1995
Control No.
Department of the Treasury
I TFRM 4-6000
NAME OF AUTHORIZED CERTIFYING
Previous edition is not usable
OFFICER (Type or print)
Date
For Disbursing Officer
REQUEST FOR ISSUANCE OF REPLACEMENT CHECK DUE TO ERROR IN NAME AND/OR DESIGNATION OF PAYEE
To Disbursing Office
Date
CHECK NO.
DATE
AMOUNT
SYMBOL NO.
VOUCHER NO.
NAME AND/OR DESIGNATION ON CHECK:
I certify that the correct name and/or
CORRECT NAME AND/OR DESIGNATION:
ADMINISTRATIVE OFFICE
designation of the payee is as shown
hereon and the amount stated is due the
LOCATION
payee. Issuance of a replacement check as
indicated, for delivery in the usual manner,
is authorized.
SIGNATURE OF AUTHORIZED
CERTIFYING OFFICER
Replacement check issued as authorized
Standard Form 1147
Rev. 5/1995
Control No.
Department of the Treasury
I TFRM 4-6000
NAME OF AUTHORIZED CERTIFYING
Previous edition is not usable
OFFICER (Type or print)
Date
For Disbursing Officer