Free 41644.PDF - Indiana

REPORT OF RECEIPTS
State Form 41644 (R3 / 12-99) Approved by State Board of Accounts 1999 DEPARTMENT OF NATURAL RESOURCES Division of Fish and Wildlife

Name of property Date submitted Call in date and time Period ending date Acceptance code Work unit Report number

SOURCE Ending Reading Beginning Reading Gross Receipts Errors Refunds Computed Record Over / Short Cash Collected PART II - COMPUTED RECEIPT BREAKDOWN Licenses Licenses Annual Launch Campground Fees Pheasant Hunt Daily Launch Annual Mooring Boat Rental Life Preserves Duck Blinds Decoys Goose Pits Field Trials Farm Contracts Crop Sales Firewood Lost Badges Annual Horse Tags Miscellaneous Calendars Recycled Federal Duck Stamp Taxes TOTAL RECEIPTS

CALENDARS

LICENSES

DNR-6

DNR-7

TOTAL COMPUTED

OVER / SHORT

TOTAL CASH

I certify that this report includes total monies collected (including overages and unreported amounts) for the period indicated and includes any amount for periods not previously paid to the State.
Prepared by Property Manager Date Date Audited by Total deposit

Date

Minus (-) Credit Cards

Cash deposit

REPORT OF ACCOUNTABLE RECEIPTS USED AND PERMITS SOLD DNR 6's Inclusive Numbers From To Number $ $ $ $ $ $ $ $ TOTAL DNR - 92's From $ DNR - 352's From TOTAL Amount DNR 7's Inclusive Numbers From To

Period ending

Number $ $ $ $ $ $ $ $ $

Amount

To

Number $ $ $ $ $ $ $ $ TOTAL $

Amount

To

Number $ $ $ $ $ $ $ $ TOTAL $

Amount

BOAT LAUNCH PERMITS From To

Number $ $ $ $ $ $ $ $ TOTAL $

Amount

BOAT MOORING PERMITS From To

Number $ $ $ $ $ $ $ $ TOTAL $

Amount

TRAFFIC COUNTER READINGS Ending Beginning Count Ending Beginning Count Ending Beginning Count

REPLACEMENT PERMITS