"Agency Fiscal Officer Designee Form" - New York City

Agency Fiscal Officer Designee Form is a legal document that was released by the New York City Department of Citywide Administrative Services - a government authority operating within New York City.

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Download "Agency Fiscal Officer Designee Form" - New York City

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Lisette Camilo
Public Service Corps
Commissioner
Dawn M. Pinnock
Fiscal Officer Designee Form
Deputy Commissioner
Human Capital
The David N. Dinkins
Agency Name: _____________________________________________________
Municipal Building
1 Centre Street
The following individual is authorized by this agency to commit funds to be
New York, NY 10007
transferred to the NYC Department of Citywide Administrative Services to cover
the 25% share of the Work-Study grant for Public Service Corps interns assigned
Public Service Corps
to this agency. As Fiscal Officer Designee, he/she will approve all agency
1 Centre Street
commitments to the Public Service Corps before they are submitted and will
th
24
Floor
insure that funds are transferred.
New York, NY 10007
Fiscal Officer
212 386 0057 tel
Designee__________________________________________________________
212 669 3633 fax
Print name
Title
psc@dcas.nyc.gov
_______________________________________________________________
Signature
Date
Address___________________________________________________________
___________________________________________________________
Phone: (
)
Fax: (
)_____________________
Email _____________________________________________________________
Budget Officer Approval______________________________________________
Please return this form to:
Department of Citywide Administrative Services
Public Service Corps
1 Centre Street, Room 2435
New York, NY 10007-1602
Or:
tdenson@dcas.nyc.gov
Lisette Camilo
Public Service Corps
Commissioner
Dawn M. Pinnock
Fiscal Officer Designee Form
Deputy Commissioner
Human Capital
The David N. Dinkins
Agency Name: _____________________________________________________
Municipal Building
1 Centre Street
The following individual is authorized by this agency to commit funds to be
New York, NY 10007
transferred to the NYC Department of Citywide Administrative Services to cover
the 25% share of the Work-Study grant for Public Service Corps interns assigned
Public Service Corps
to this agency. As Fiscal Officer Designee, he/she will approve all agency
1 Centre Street
commitments to the Public Service Corps before they are submitted and will
th
24
Floor
insure that funds are transferred.
New York, NY 10007
Fiscal Officer
212 386 0057 tel
Designee__________________________________________________________
212 669 3633 fax
Print name
Title
psc@dcas.nyc.gov
_______________________________________________________________
Signature
Date
Address___________________________________________________________
___________________________________________________________
Phone: (
)
Fax: (
)_____________________
Email _____________________________________________________________
Budget Officer Approval______________________________________________
Please return this form to:
Department of Citywide Administrative Services
Public Service Corps
1 Centre Street, Room 2435
New York, NY 10007-1602
Or:
tdenson@dcas.nyc.gov