Receiving Report and Authorization for Payment
CHR 101 COMMONWEALTH OF KENTUCKY (Rev 3-86) CABINET FOR HEALTH AND FAMILY SERVICES RECEIVING REPORT AND AUTHORIZATION FOR PAYMENT Received from: For Central Office USE ONLY TO BE COMPLETED WHEN PAYMENT IS MADE Account No. Check No. Amount Paid Date Paid Authority No. Program Code Organizational Control No. Order No. Invoice No. … ................
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