It is prepared in duplicate for each inmate when he receives funds. Manilla Envelope which is obsolete. Print or white or manila envelope. There are no electronically fillable objects on this form. V1 replaces 20001201 edition which is obsolete and changes form title to comply with program change.
Form is used in the administration of confinement facilities worldwide.
It will be completed by the inmate when he desires to have funds withdrawn from his account when authorized. The form will be attached to the Petty Cash Voucher as a supporting paper when the funds are paid from petty cash. It will support the Disbursement Voucher when the request is paid by check. Changes form title and replaces 19691101 edition which is obsolete and which should be retained according to user's specific electronic records keeping requirements. Form is used in the administration of confinement facilities world-wide when common items such as hair cuts, monies, laundry, etc. are purchased by a group of inmates.