APPENDIX D: CHECK REQUEST

CITY OF SOMERTON

Form Number 105

(Rev. 03/93)

CHECK REQUEST

Payable To

ACCOUNT	EXPLANATION	AMOUNT
TOTAL AMOUNT OF REQUEST		$

 

REQUESTED BY:    DATE:

APPROVED BY    DATE / /

APPROVED BY    DATE / /

PREPARED BY    DATE / /

CHECK NUMBER:

(Res. 2008-011, passed 2-19-2008)