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Completing the Form: The Payee is to complete the following information: Field 1 Request. 1a. Name of the state where the payee is completing the Receipt. 1b.A nonmonetary transaction includes the exchange of goods or services without actual money changing hands. Instant access to fillable Microsoft Word or PDF forms. Minimize the risk of using outdated forms and eliminate rejected fillings. The BSF241, Nonmonetary General Receipt, which is the CBSA's official receipt, is "Protected A" when completed. 2. Fill out the nebraska payee affidavit for non monetary receipt form form for FREE! Income Withholding Termination Form paid to CDC (Clerk of the District Court). Non-monetary receipts (Clerk of the District Court and CHARTS). A: General Information on ACH Non-Receipt Claims .