PRC form - Housing ChoicePayment RequestDocument - Input Form The Commonwealth of Massachusetts
PRCOCD PVOCD 3210 0000
Action: N | Department of Housing and Community Development
HEADER
VENDOR
Vendor Name and Address
Document Name:
Record Date:
Budget FY: 20
Fiscal Year: 20
Period:
Doc. Description:
Doc Total:
Disbursement Options
Sched. Paymnt Date:
Single Payment: Handling Code:
Vendor Cust.# VC600019
Vendor’s Certification:
I certify that the goods were shipped or the service rendered as set forth below.
X___________________________________
(Please sign in ink)
COMMODITY
ACCOUNTING
FUND ACCOUNTING
Commodity Code: 841015010000
Line Type:
Contract Amount:
Service From:
Service To:
Reference
Comm. Ref. Code:CT
Comm. Ref. Dept.: OCD
Comm. Ref. ID
SC OCD 3210 0000
Comm. Reference VL:
Comm. Reference CL: 1
Ref. Type Partial
Invoice Information
Vendor Invoice # :
Vendor Invoice Line : 1
Vendor Invoice Date:
Event Type: AP01
Fund: 0200
Budget FY: 20
Sub Fund:
Fiscal Year: 20
Department: OCD
Period:
Unit: 3210
Line/Check Description:
Approp Unit #:
Object: PO1
Line Amount
Detail Accounting
Program:19HCHOICE
Program Period:EPP
$
Ref Acct. Line
Ref Type: Partial
TO THE COMPTROLLER OF THE COMMONWEALTH OF MASSACHUSETTS
I hereby certify under the penalties of perjury that all laws of the Commonwealth of Massachusetts governing disbursements of public funds and the regulations thereof have been complied
with and observed.
Prepared by: _____________________________________________ Title Fiscal RepresentativeDate_________________
Approved by: ____________________________________________ Title Fiscal DirectorDate _________________
Entered by: _____________________________________________ Title _________________________ Date _________________ rev10/20/2015