Free Instructions for the Completion of Payment Vouchers - New Jersey

Instructions for the Completion of Foreclosure Mediation Payment Voucher On the hearing day, each foreclosure mediator is given a payment voucher on which to record his or her cases. The vouchers are collected at the end of the day and are to be processed as follows: Space A: the Payee Identification Number should be either the mediator's firm's federal reporting number for tax purposes (if the firm is to receive reimbursement) or the mediator's Social Security Number (if the mediator is to be reimbursed as an individual). Space C: the total amount should be $200.00. Space D: if the mediator's firm is to receive the reimbursement, print the complete name of the mediator's law firm first, then the firm's address. If the mediator is to be reimbursed individually, use his or her name first, followed by the address to which the check should be sent. Space F: the mediator must sign the Payee Declaration, and his or her name must be printed or typed below the signature. Commodity Code/Description of Item: To be completed by the Civil CDR Point Person. They will list the docket numbers of each case handled by the mediator. Checks will be issued after the invoices have been processed through the AOC Fiscal Unit. The check will be sent directly to the payee name and address listed in space D. The Civil CDR Pointer Person should sign in the block denominated Certification by Receiving Agency (lower left hand corner). The mediator seeking payment must sign in the Declaration section. Invoices should be submitted weekly. They should not be accumulated over a prolonged period.

Published 01/2009, CN 11292-English (Foreclosure Mediation Payment Voucher)

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STATE OF NEW JERSEY

DOCUMENT
TC AGY NUMBER TC AGY

BATCH
NUMBER

PAYMENT VOUCHER
(VENDOR INVOICE)
PO #
CONTRACT NO AGENCY REF BUYER (B)

ACTG PER. VENDOR ID NUMBER

FY

PP START
MO DY YR

SCHED PAY
MO DY YR

PV DATE

CHK OFF CAT LIAB

F A

RF TY

CK FL

(A)

TERMS

PAYEE:

SEE INSTRUCTIONS FOR COMPLETING ITEMS (A) THROUGH (G) (E)

(C)

TOTAL AMOUNT

$0.00

(D)

PAYEE NAME AND ADDRESS:

SEND COMPLETED FORM TO:

Judiciary R.J. Hughes Justice Complex P.O. Box 985 Trenton, NJ 08625 Attn: Maria Petersack Accounting 8th Floor, North Wing
(F) PAYEE DECLARATIONS

I CERTIFY THAT THE WITHIN PAYMENT VOUCHER IS CORRECT IN ALL ITS PARTICULARS, THAT THE DESCRIBED GOODS OR SERVICES HAVE BEEN FURNISHED OR RENDERED AND THAT NO BONUS HAS BEEN GIVEN OR RECEIVED ON ACCOUNT OF SAID DOCUMENT.

FFFFF
PAYEE SIGNATURE

PAYEE TITLE LINE NO 1 2 3
FUND AGCY ORG CODE SUB-ORG APPR UNIT ACTIVITY CD OBJECT CD SUB-OBJ REV SRCE SUB-REV

BILLING DATE

REFERENCE
CD AGY NUMBER LINE

(G)

PAYEE REFERENCE

PROJECT/JOB NO

1 2 3

71G

098

Y950

001

3620

RPT CT

BS ACT

DT

DESCRIPTION

QUANTITY

AMOUNT

ID PF TX

1 2 3 ITEM NO. COMMODITY CODE / DESCRIPTION OF ITEM QUANTITY UNIT UNIT PRICE AMOUNT

#1

$0.00

#2

$0.00

#3

$0.00

TOTAL
CERTIFICATION BY RECEIVING AGENCY: I certify that the above articles have been received or services rendered as stated herein. CERTIFICATION BY APPROVAL OFFICER: I certify that this Payment Voucher is correct and just, and payment is approved.

$0.00

Authorized Signature

Authorized Signature

Title PV OMAS Form Control, 1/00 (CN 10355-English)

Date

Title

Date

Published 01/2009, CN 11292-English (Foreclosure Mediation Payment Voucher)

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