7/23/2019 Instructions on Reports of Checks Issued (RCI) Form

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REPORT OF CHECKS ISSUED

__________________________________________Agency

Period Covered: ________________

Bank Name/Account No. _________________

Check DV No. / Resonsi!i"ityPayee

Date No. Payro"" Center Code

CERTIFICATION

$ here!y certi#y that this Reort o# Checks $ssued in _________ she

statement o# a"" checks re"eased !y me in ayment #or o!"iga

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7/23/2019 Instructions on Reports of Checks Issued (RCI) Form

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statement o# a"" checks re"eased !y me in ayment #or o!"iga