Cash Receipt Template 1
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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
(2)

I certify that I received cash in the amount of $

Address
for

Signature
(3)

I certify that I received cash in the amount of $

Address
for

Signature
(4)

I certify that I received cash in the amount of $

Address
for

Signature
(5)

I certify that I received cash in the amount of $

Signature

Address
for

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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