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["Business Unit:","Rotary District 5050",{"$nulls":5},"US Funds",null,"CDN Funds"]
[]
["Date of Request:"]
[]
["Reason for Funds",{"$nulls":4}," "]
[null,null,"(Receipt or invoice must accompany this check/cheque requisition form)"]
["Payee:"]
[null,"Please Print Legibly"]
["Address:  "]
[]
[]
[]
[null,"Budget Account Code",{"$nulls":4},"Description (Optional)",{"$nulls":3},"Amount"]
{"$rows_empty":9}
[{"$nulls":7},"Total Amount Payable"]
[{"$nulls":10},"."]
[]
["District Governor Authorization"]
[]
[]
[]
[]
[]
["Comments:",{"$nulls":7},"Accrued (M.E.)"]
[]
[{"$nulls":9},"Mail Out "]
[]
[{"$nulls":9},"Return Check/Cheque To:"]
[]
[{"$nulls":8},"Due Date:"]
["Prepared by:"]
[null,"Please print"]
["District Use Only"]
["Vendor Number:",null,null,"Invoice Number:",{"$nulls":5},"Invoice Date:"]
[]
[]
["Date Received",{"$nulls":6},"Date Paid"]
[]
[]
[]
["Instructions for Use:"]
["This form should be used any time a Rotarian needs to request a check to be sent directly to a third party."]
[]
["If reimbursement is required for expense(s) already paid by the Rotarian - please use the District Expense Form."]