Stop Payment Request - California

STATE OF CALIFORNIA - STATE TREASURER

STOP PAYMENT REQUEST STD. 432 (Rev. 10/2019)

ACCOUNT #

YOU ARE AUTHORIZED TO

STOP PAYMENT

RELEASE STOP PAYMENT

REASON

STOLEN OR MISSING BLANK STOCK CHECK(S)

CONFIRMATION

ON (Submission Date)

STALE DATED CHECK (OVER 1 YEAR OLD) ACCOUNT NAME

CHECK #

IS CHECK TO BE REISSUED

YES

NO

OTHER

ISSUING AGENCY MAILING ADDRESS

AGENCY CONTACT PERSON (Type or Print) AGENCY AUTHORIZED SIGNATURE

TELEPHONE NUMBER (ATSS)

PAYEE NAME

ISSUE DATE

AMOUNT

$

STATE TREASURER'S ACKNOWLEDGEMENT

STOP PAYMENT

RELEASE

TREASURER'S AUTHORIZED SIGNATURE

NOT CHECKED FOR PAYMENT

DATE EFFECTIVE

STATE OF CALIFORNIA - STATE TREASURER

STOP PAYMENT REQUEST STD. 432 (Rev. 10/2019)

ACCOUNT #

YOU ARE AUTHORIZED TO

STOP PAYMENT

RELEASE STOP PAYMENT

REASON

STOLEN OR MISSING BLANK STOCK CHECK(S)

CONFIRMATION

ON (Submission Date)

STALE DATED CHECK (OVER 1 YEAR OLD) ACCOUNT NAME

CHECK #

IS CHECK TO BE REISSUED

YES

NO

OTHER

ISSUING AGENCY MAILING ADDRESS

PAYEE NAME

AGENCY CONTACT PERSON (Type or Print) AGENCY AUTHORIZED SIGNATURE

TELEPHONE NUMBER (ATSS)

ISSUE DATE

AMOUNT

$

STATE TREASURER'S ACKNOWLEDGEMENT

STOP PAYMENT

RELEASE

TREASURER'S AUTHORIZED SIGNATURE

NOT CHECKED FOR PAYMENT

DATE EFFECTIVE

STATE OF CALIFORNIA - STATE TREASURER

STOP PAYMENT REQUEST STD. 432 (Rev. 10/2019)

ACCOUNT #

YOU ARE AUTHORIZED TO

STOP PAYMENT

RELEASE STOP PAYMENT

REASON

STOLEN OR MISSING BLANK STOCK CHECK(S)

CONFIRMATION

ON (Submission Date)

STALE DATED CHECK (OVER 1 YEAR OLD) ACCOUNT NAME

CHECK #

IS CHECK TO BE REISSUED

YES

NO

OTHER

ISSUING AGENCY MAILING ADDRESS

PAYEE NAME

AGENCY CONTACT PERSON (Type or Print) AGENCY AUTHORIZED SIGNATURE

TELEPHONE NUMBER (ATSS)

ISSUE DATE

AMOUNT

$

STATE TREASURER'S ACKNOWLEDGEMENT

STOP PAYMENT

RELEASE

TREASURER'S AUTHORIZED SIGNATURE

NOT CHECKED FOR PAYMENT

DATE EFFECTIVE

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