Free 49068.xls - Indiana

REQUEST FOR SDO ACCOUNT ESTABLISHMENT, ADJUSTMENTS AND NEW OFFICER
State Form 49068 (R3 / 1-08) Approved by Auditor of State, 2008 Approved by State Board of Accounts, 2008

Reset Form
Local purchase number Business Unit Number Telephone number Account

Please use this form, with a justification letter, to request a new SDO Account or to request adjustment to an existing one (Reference Procurement Manual).

Date (month, day, year) Name of Business Unit Name of Business Unit Head Fund

For Establishment of an new Account:
Name of new SDO As a new SDO, are you also a procurement agent? Yes Requested single-purchase limit: No Requested major accounts: Requested Amount:

For Adjustments to Existing Account:
Advance Amount: Major Accounts:: Single-Purchase Limit:

REQUESTED

CURRENT

For Transfer of SDO Funds to new Special Disbursement Officer:
Name of new SDO: As a new SDO, are you also a procurement agent? Yes No

I accept the responsibility for the above advance as outlined in Chapter 9 of the Accounting and Uniform Compliance Guidelines Manual for State Agencies (State Accounting Manual) and in policy and procedure memorandums issued by the Department of Administration and the Auditor of State. Signature of new SDO Date (month, day, year)

Approved:
Signature of Business Unit Head Signature of Commissioner, IDOA or Designee Signature of Auditor of State or Designee Date (month, day, year) Date (month, day, year) Date (month, day, year)

Please attach this form to your justification letter.