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Get State Of Illinois Form C 13

Print Form Invoice Voucher FORM C-13 REV. 4/09 STATE OF ILLINOIS Name and Location of State Agency or Institution PAYMENT OF INTEREST MAY BE AVAILABLE IF THE STATE FAILS TO COMPLY WITH THE STATE PROMPT PAYMENT ACT 30 ILCS 540. 2. Taxpayer Identification Number 4. Voucher No* 5. Voucher Date 3. Vendor or Payee LAST NAME OR BUSINESS NAME 6. Appropriation Account Code FIRST NAME MIDDLE INITIAL 7. Invoice Number Disposition of Copies Comptroller Agency Remittance Copy 8. Invoice Date 7. Retained by Vendor 10. Indicate Beginning and Ending Date of Service and GAAP Code. Give Complete Description of Articles/Services Rendered or Attach Itemized Vendor Invoice 18. Exp* Obj 19. Exp* Amount 11. Quantity 12. Units 13. Unit Price 14. Amount 20. CFDA No* Subtotal 23. Payment Amount 22. Obligation No* Discount / Deduction 21. Total Exp* Total Amount 24. Total Payment Amount 25. For Agency Use Only Certification of Receiving Agency I certify that the goods or services specified on this voucher were for the use of this agency and that the expenditure for such goods or services was authorized and lawfully incurred that such goods or services meet all the required standards set forth in the purchase agreement or contract to which this voucher relates and that the amount shown on this voucher is correct and approved for payment. If applicable the reporting requirements of section 5. 1 of the Governor s Office of Management and Budget Act have been met. Approved for Payment Receiving Officer Date Head of Unit or Authorized Agent C-13 4/09 Clerk Agency Head Signature. 2. Taxpayer Identification Number 4. Voucher No* 5. Voucher Date 3. Vendor or Payee LAST NAME OR BUSINESS NAME 6. Appropriation Account Code FIRST NAME MIDDLE INITIAL 7. Invoice Number Disposition of Copies Comptroller Agency Remittance Copy 8. Appropriation Account Code FIRST NAME MIDDLE INITIAL 7. Invoice Number Disposition of Copies Comptroller Agency Remittance Copy 8. Invoice Date 7. Retained by Vendor 10. Indicate Beginning and Ending Date of Service and GAAP Code. Invoice Date 7. Retained by Vendor 10. Indicate Beginning and Ending Date of Service and GAAP Code. Give Complete Description of Articles/Services Rendered or Attach Itemized Vendor Invoice 18. Exp* Obj 19. Give Complete Description of Articles/Services Rendered or Attach Itemized Vendor Invoice 18. Exp* Obj 19. Exp* Amount 11. Quantity 12. Units 13. Unit Price 14. Amount 20. CFDA No* Subtotal 23. Payment Amount 22. Exp* Amount 11. Quantity 12. Units 13. Unit Price 14. Amount 20. CFDA No* Subtotal 23. Payment Amount 22. Obligation No* Discount / Deduction 21. Total Exp* Total Amount 24. Total Payment Amount 25. For Agency Use Only Certification of Receiving Agency I certify that the goods or services specified on this voucher were for the use of this agency and that the expenditure for such goods or services was authorized and lawfully incurred that such goods or services meet all the required standards set forth in the purchase agreement or contract to which this voucher relates and that the amount shown on this voucher is correct and approved for payment.

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