1. North Carolina State University Cash Receipt Certification
Certification of receipt of cash from NC State University in connection with
(1)
I certify that I received cash in the amount of $ for
Signature Address
I certify that I received cash in the amount of $ for
(2)
Signature Address
I certify that I received cash in the amount of $ for
(3)
Signature Address
I certify that I received cash in the amount of $ for
(4)
Signature Address
I certify that I received cash in the amount of $ for
(5)
Signature
Address
I hereby certify that I have disbursed the stated amounts and have reviewed proper identification of each individual listed above:
(Signature of Custodian)
Date
Form GA-082a Rev 04/07/00
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