- Check Number - From the issued check to be cancelled, enter the check number. Only one check per form.
- Check Date - Enter the date of issue on check to be cancelled.
- Amount - Enter the amount of the issued check to be cancelled.
- Payee - Enter to whom the check was made payable.
- Address - Enter the address of the payee (if available).
- Reason - Enter a detailed reason why the check is to be cancelled.
- Requestor - Enter the person's name requesting the check to be cancelled
- Requestor's Department - Enter the requestor's department name.
- Requestor's Phone - Enter the requestor's telephone number.
- Budget Code Table - This table has seven columns with one header row and three data rows.The table is for the distributon of charges from the request for payment that was originally submitted.
- Voucher - Enter the voucher number
- Department - Enter the department number
- Fund Name - Enter the fund name
- Fund Number - Enter the fund number
- Object Code - Enter the object classification code
- Project Number - Enter the project number (if applicable)
- Amount - Enter the amount charged to this budget code