Systems and Procedures
A Division of The Corporate Controller's Office


Table of Contents:


One version of this form is to be completed for monies received in the name of the University when another document is not designated as a receipt. This form will provide a permanent record supporting the posting of payments to financial records, and also provides a receipt to individuals making payments.

General Information:

Exhibits and Instructions:

To view exhibits, click below:

Prenumbered Receipt (UP)

Prenumbered Receipt (CC)

Form Requirements:

No form may be used that substitutes for an approved official University form without prior review and approval by the steward of the form/central office, as facilitated by the Office of Systems and Procedures (designated representative of the Corporate Controller). See Policy FN17 - Required Use of Approved University Forms Appearing in the General University Reference Utility (GURU) for full details.

GURU PDF forms are designed for use with Adobe Acrobat Reader or Adobe Acrobat Pro. Each brower (Chrome, Firefox, Internet Explorer, etc.) has a built-in PDF viewer making it the default PDF neiwwer without asking users. These built-in viewers do n ot necessarily support all features required for PDF forms. Similarly, many calculations are not supported by other stand-alone PDF reader (for example, Nuance). If you experience problems downloading or opening documents, right click on the link on the Forms Locator Screen, select 'Save Link As' (or similar language) and save the file. The document can then be opened in either Adobe Acrobat Reade or Adobe Acrobat Pro from the saved location.

The latest version of Adobe Acrobat Reader is available for free. Contact your IT support staff person for downloading assistance, if/as needed. If Adobe Acrobat Pro better suits your eeds, contact your IT support staff person for purchasing and installation assistance.

If your encounter any difficulties, contact the GURU support staff by submitting a Technical Support Form request or by calling the tech support line at 814-863-8592.

Number of Copies and Ultimate Distribution:

Table of distribution and retention of the Request for Prenumbered Receipt form
Ultimate Distribution: Retention Periods:
(after settlement)
Original White Person making payment - - - - -
1st Copy Canary * Area accepting payment Current fiscal year +2 years, or until released by Auditing, whichever comes first
2nd Copy Pink * Financial Officer Current fiscal year +2 years, or until released by Auditing, whichever comes first

* This distribution may be interchanged.

Where to Send Completed Forms:

University Park:

At Other Locations:

Contact Information:

For questions, additional details, or to request changes to this form, please contact Systems & Procedures.

Cross References: