Appendix _____

CASH JOURNAL
Month ______________________
Agency _________________
Fund _________________ Sheet No. ______________

C O L L E C T I O N S R E M I T T A N C E

Credit Debit

Date RCD No. JEV No. Name of Collecting Debit SUNDRY SUNDRY Credit

Officer 106 Acct. Code P Amount Acct. Code P Amount 106

 Appendix

CHECK DISBURSEMENTS JOURNAL

Month
Agency
Fund Sheet No.

Serial No. of CREDIT DEBIT

Name of
Checks Disbursing S UND R Y SUNDRY
DATE JEV RCI/DV Officer
No. No. From To Acct. Code P Amount Acct. Code P Amount
21

AO 5-14-02
 Appendix ______

CASH DISBURSEMENTS JOURNAL

Month ___________________________
Agency
Fund Sheet No.

CREDIT DEBIT

SUNDRY SUNDRY
DATE JEV No. RD No. Name of Disbursing Officer

Acct. Code P Amount P

Acct. Code Amount
23

AO 5-14-02
 Appendix ______

CHECK DISBURSEMENTS RECORD

Agency
Fund Sheet No.

Accountable Officer Official Designation Station

Check NCA
Date Date Name of Payee UACS Code Nature of Payment Received/ Checks Bank/NCA
No. Released Deposit Made Issued Balance

Received

CERTIFICATION

I hereby certify that the foregoing is a correct and complete record of all checks
issued by me in my capacity as ____________________ of ___________________________
______________ during the period from _______________ to _______________, inclusives,
as indicated in the corresponding columns.

___________________________
Name and Signature
________________
Date
For Accountable Officers' Use
 Appendix 35

REPORT OF CHECKS ISSUED

Period Covered: ________________

Entity Name : ____________________________________________

Fund Cluster : ___________________________________________ Report No.: __________
Bank Name/Account No. : __________________________________ Sheet No.: ___________

Check Responsibility UACS Object

DV/Payroll No. ORS/BURS No. Payee Nature of Payment Amount
Date Serial No. Center Code Code
98

C E R T I F I CAT I O N
I hereby certify on my official oath that this Report of Checks Issued in _________ sheet(s) is a full, true and correct
statement of all checks issued by me during the period stated above for which Check Nos. ___________ to _____________ inclusive,
were actually issued by me in payment for obligations shown in the attached disbursement vouchers/payroll.

____________________________________________
Name and Signature of Disbursing Officer/Cashier
_____________________________ ______________
Official Designation Date