STATE OF ALABAMA



STATE OF ALABAMA

DEPARTMENT OF FINANCE

DIVISION OF CONTROL AND ACCOUNTS

PAYROLL WARRANT/EFT/PRE-PAID DEBIT CARD FUNDING CANCELLATION REQUEST

Agency Code:     Agency Name:      

Warrant/EFT/Debit Card Funding Number:      

Employee ID:      

Employee Name:      

Net Amount: $      

Warrant/EFT/Debit Card Funding Date:     /    /    

Why is warrant, EFT or Debit Card Funding being canceled? (1000 characters available)      

Is warrant, EFT or Debit Card Funding being replaced? Yes No

Has employee left State service? Yes No

Has RSA-7 (Notice of Final Deposit & Request for Refund) been submitted to RSA? Yes No

If the RSA-7 has been submitted to Retirement Systems, the warrant cannot be canceled and must be receipted into the State Treasury.

The attached warrant listed above is submitted for cancellation.

Authorized Departmental Approval: _______________________________________________________

Submitted By:      

Phone #:      

Date:     /     /     

-----------------------

For Comptroller’s Use Only:

CHCK _____ R/N _____ R/Y _____ QCHK _____

Processed by: ____________________ Date: _____ _____ / _____ _____ / _____ _____

Verified by: ______________________ Date: _____ _____ / _____ _____ / _____ _____

NOTE: IF CANCELING AN EFT YOU MUST CONTACT COMPTROLLER’S OFFICE PAYROLL FOR APPROVAL. CALL THE GHRS HOTLINE AT 242-2188.

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