REPORT OF COLLECTIONS / RECEIPTS (DUE TREASURER OF STATE)
State Form 14311 (R2 / 12-02)
FOR TREASURER USE ONLY
Approved by State Board of Accounts, 2002 Approved by Auditor of State, 2002
LINE NUMBER
FUND NUMBER
OBJECT
CENTER
AMOUNT
DESCRIPTION
GRAND TOTAL Currency Silver Checks Deposits Wire Transfers Lock Box Debts Credits ACH TOTAL Title
Prepared by:
Date prepared:
Preparer's telephone number
I certify that this report is true and correct to the best of my knowledge and belief.
Signatue of agency official or designee
Name of state agency
Agency number
DISTRIBUTION: White - Auditor of State; Canary - Agency after processing; Pink - Treasurer