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           Check One "R"      DIRECT PAY COVER SHEET
               EMPLOYEE REIMBURSEMENT   REV'D 2-13-02
           
               OTHER REIMBURSEMENT  
     
   BANNER DOCUMENT NUMBER "R"   TRANSACTION         VENDOR INVOICE  
   (CAPITAL I, ZERO, SIX DIGITS)                    DATE    
                MISCELLANEOUS PAYMENT  
         
           
           
   PAYEE "R"     AUTHORIZED APPROVER SIGNATURE   DATE
 $          
           
   AMOUNT     FUND - ORG - ACCOUNT - LOCATION   PICKUP CODE
         
         
   DEPARTMENT "R"     USER DEFINED  
         
         
   RESPONSIBLE PARTY "R"     USER DEFINED  
             
             
   EMAIL ADDRESS "R"   PHONE EXT   USER DEFINED  
 "R" = REQUIRED ENTRY                
   COMMENTS:  
                 
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