Free 22933.xls - Indiana

VOUCHER ABSTRACT -- FORM A-3 State Form 22933 (R 3/1-96) Approved by State Board of Accounts, 1996. AGENCY NOTICE: Use this form as a coverniing transmittal for vouchers chargeable.
Send two copies to the Auditor of the State of Indiana.

DOCUMENT NUMBERS
Starting Number Ending Number Date (Month, Day, Year)

AGENCY FILL IN SIGNATURES FOR APPROVAL
Department of Administration Signature Date Received (Mo., Day, Yr.) Budget agency Signature Date Approved (Mo., Day, Yr.) Fund / Object / Center Agency Name Agency Number

AGENCY LEAVE BLANK
Date Received (Mo., Day, Yr.) Date Approved (Mo., Day, Yr.) Control Group Number

PAYEE
(Double space, use reverse side if necessary)

AMOUNT

TOTAL: