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[null,null,null,null,null,"PAYMENT REQUEST & VOUCHER",null,null,null,"Check #:"]
[null,null,null,null,null,"Health Science Center at Brooklyn Foundation, Inc.",null,null,null,"Check date:"]
[null,null,null,null,null,"(Form must be completed in Excel. Mail completed form to MSC 1219 or hand deliver to Student Center, Room 2-09)"]
[]
[]
["DATE OF REQUEST:",null,null,null,null,"REQUESTOR:"]
[]
["ORGANIZATION OR"]
["DEPARTMENT:"]
[]
["PROJECT NUMBER",null,null,null,null,null,"PROJECT"]
["TO BE CHARGED:",null,null,null,null,null,"TITLE:"]
[]
["TOTAL CHECK",null,null,null,"    CHECK DRAWN",null,null,"PICK UP CHECK AT HSCBF OFFICE"]
["AMOUNT:",null,null,null,"    PAYABLE TO:",null,"Payee name:"]
[null,null,null,null,null,null,"Address:"]
[null,"1) attach original invoice"]
[null,"2) attach receipt of goods or services",null,null,null,null,"City, State, Zip:"]
[]
["PURPOSE - BE SPECIFIC ABOUT PURPOSE, AND ATTACH ANY AND ALL NECESSARY ADDITIONAL SUPPORTING"]
["DOCUMENTATION, SUCH AS LETTERS OF EXPLANATION/JUSTIFICATION, MEETING MINUTES, CONTRACT, ETC."]
["NOTE - ADVANCES, WHEN APPROVED, MAY BE ISSUED, HOWEVER RECEIPTS MUST BE SUBMITTED WHEN"]
["RECEIVED.  FAILURE TO RETURN RECEIPTS WILL RESULT IN ACCOUNT BEING FROZEN."]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"AUTHORIZED",null,null,null,null,null,"Name (please type or print)"]
[null,"SIGNATURE",null,null,null,null,null,"Organization Title"]
[]
["WHEN SECOND SIGNATURE IS REQUIRED BY ORGANIZATION:"]
[]
[null,"AUTHORIZED",null,null,null,null,null,"Name (please type or print)"]
[null,"SIGNATURE",null,null,null,null,null,"Organization Title"]
[]
["DO NOT WRITE BELOW THIS LINE - FOR HSCBF OFFICE USE ONLY"]
["ACCOUNT NUMBER",null,"ACCOUNT TITLE",null,null,null,null,"DEBIT",null,"CREDIT"]
[]
[]
[]
[]
[]
[]
[null,"CHECK RECEIVED BY ",null,null,null,null,null,"DATE ",null,"BATCH # "]