Form FMS-103-F5 Exhibit I "Pending/Missing Pc Alert Receipt Form" - Florida

The Florida Department of Juvenile Justice has released this version of the "Pending/Missing Pc Alert Receipt Form" on March 3, 2009.

This form may be used by all Florida residents: download the printable PDF by clicking the link below and use it according to the applicable legal guidelines.

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Download Form FMS-103-F5 Exhibit I "Pending/Missing Pc Alert Receipt Form" - Florida

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DEPARTMENT OF JUVENILE JUSTICE
FINANCE & ACCOUNTING
PENDING/
MISSING PC ALERT RECEIPT FORM
CARDHOLDER NAME: ________________________________________________________
ORDER DATE: _______________________________________________________________
VENDOR NAME: _____________________________________________________________
PURCHASE AMOUNT: ________________________________________________________
DESCRIPTION OF PURCHASE: _________________________________________________
QUANTITY ORDERED: ________________________________________________________
DO/MA
NUMBER: ____________________________________________________________
SHIPPING AND HANDLING CHARGES, IF ANY: ____________________________________
OTHER CHARGES, IF ANY DESCRIBE: ___________________________________________
____________________________________________________________________________
Cross Reference Invoice#
______________________________________________________
RECEIPT WAS (check one): _________ LOST _________ NOT OBTAINABLE
I CERTIFY THAT THE ABOVE PURCHASE WAS MADE FOR OFFICIAL STATE BUSINESS.
______________________________________ __________________________________
CARDHOLDER SIGNATURE
SUPERVISOR SIGNATURE
______________________________________ _________________________________
DATE
DATE
PCARD STAMP HERE:
Revised 3/3/2009
DJJ-Purchasing Card
Pending/Missing PC Receipt Form
Exhibit I
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DEPARTMENT OF JUVENILE JUSTICE
FINANCE & ACCOUNTING
PENDING/
MISSING PC ALERT RECEIPT FORM
CARDHOLDER NAME: ________________________________________________________
ORDER DATE: _______________________________________________________________
VENDOR NAME: _____________________________________________________________
PURCHASE AMOUNT: ________________________________________________________
DESCRIPTION OF PURCHASE: _________________________________________________
QUANTITY ORDERED: ________________________________________________________
DO/MA
NUMBER: ____________________________________________________________
SHIPPING AND HANDLING CHARGES, IF ANY: ____________________________________
OTHER CHARGES, IF ANY DESCRIBE: ___________________________________________
____________________________________________________________________________
Cross Reference Invoice#
______________________________________________________
RECEIPT WAS (check one): _________ LOST _________ NOT OBTAINABLE
I CERTIFY THAT THE ABOVE PURCHASE WAS MADE FOR OFFICIAL STATE BUSINESS.
______________________________________ __________________________________
CARDHOLDER SIGNATURE
SUPERVISOR SIGNATURE
______________________________________ _________________________________
DATE
DATE
PCARD STAMP HERE:
Revised 3/3/2009
DJJ-Purchasing Card
Pending/Missing PC Receipt Form
Exhibit I
Reset/Clear Form
Save As
Print Page
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