Attachment 1 "Request for Advance Payment of Membership Dues in Proffessional or Other Organizations" - Florida

This "Attachment 1 - Request for Advance Payment of Membership Dues in Proffessional or Other Organizations" is a Florida-specific form released by the Florida Department of Juvenile Justice on June 1, 2018.

Download the form by clicking the link below, fill it out by hand, and mail it as per the guidelines provided by the department or the applicable legal instructions.

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Download Attachment 1 "Request for Advance Payment of Membership Dues in Proffessional or Other Organizations" - Florida

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FLORIDA DEPARMTENT OF JUVENILE JUSTICE
FDJJ 1407.04
REQUEST FOR ADVANCE PAYMENT OF MEMBERSHIP
ATTACHMENT 1
DUES IN PROFFESSIONAL OR OTHER ORGANIZATIONS
REQUESTERS INFORMATION:
_______________________________
_______________________
________________
Requester
Org. Code
Expansion Option
_______________________________
________________________
________________
Street Address
Contact Person
Telephone Number
_______________________________
________________________
________________
City
State
Zip Code
ORGANIZATION INFORMATION:
_________________________________
_________________________
_________________
Name of Organization
Division/Program Office
Telephone Number
_________________________________
_______________________
________________
City
State
Zip Code
PRIOR FISCAL YEAR MEMBERSHIP INFORMATION:
_______________________________________
________________________________
Name/Title
Membership Type
________________________
________________________________
Amount
Period
CURRENT FISCAL YEAR MEMBERSHIP INFORMATION:
______________________________________
________________________________
Name/Title
Membership Type
________________________
________________________________
Amount
Period
1 |
P a g e
REVISED: 6/2018
FLORIDA DEPARMTENT OF JUVENILE JUSTICE
FDJJ 1407.04
REQUEST FOR ADVANCE PAYMENT OF MEMBERSHIP
ATTACHMENT 1
DUES IN PROFFESSIONAL OR OTHER ORGANIZATIONS
REQUESTERS INFORMATION:
_______________________________
_______________________
________________
Requester
Org. Code
Expansion Option
_______________________________
________________________
________________
Street Address
Contact Person
Telephone Number
_______________________________
________________________
________________
City
State
Zip Code
ORGANIZATION INFORMATION:
_________________________________
_________________________
_________________
Name of Organization
Division/Program Office
Telephone Number
_________________________________
_______________________
________________
City
State
Zip Code
PRIOR FISCAL YEAR MEMBERSHIP INFORMATION:
_______________________________________
________________________________
Name/Title
Membership Type
________________________
________________________________
Amount
Period
CURRENT FISCAL YEAR MEMBERSHIP INFORMATION:
______________________________________
________________________________
Name/Title
Membership Type
________________________
________________________________
Amount
Period
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REVISED: 6/2018
JUSTIFICATION AND BENEFITS TO THE STATE:
AUTHORIZATION:
______________________________________
________________________________
Agency Head or Authorized Designee
Date
REQUIRED ATTACHMENTS:
A. Requisition Number.
B. Notarized Vendor’s Certification of Availability of Records and that State Funds will not be used for
Lobbying as in accordance with Florida Statue, 119.012.
C. Non-Acceptance of Institutional Membership Statement, if required.
D. Quote from Vendor.
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REVISED: 6/2018
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