Form Standard Voucher PDF Details

The Standard Voucher form, identified as AC92 and last revised in June 1994, serves as a critical document within the financial operations of the State of New York, facilitating transactions between the state and its suppliers or service providers. This comprehensive form ensures a structured and formalized process for payments, capturing essential details such as the originating agency, voucher numbers, payment and liability dates, and specifics concerning the payee like identification numbers, addresses, and the nature of goods or services provided. Key features of the form include sections for payee certification, agency pre-audit confirmations, and meticulous instructions for vendors on how to accurately complete the voucher, thereby minimizing errors and streamlining the payment process. The form also incorporates guidelines on sales tax exemption, reinforcing the state's commitment to adherence to tax laws and fiscal responsibility. It's designed to cater to a wide range of transactions, highlighted by its capacity to accommodate detailed descriptions of materials or services and the inclusion of pertinent financial details, ensuring clarity and accountability in the state’s financial dealings. This thorough approach embodied in the Standard Voucher form underscores the state's dedication to maintaining a transparent, efficient, and reliable financial management system.

QuestionAnswer
Form NameForm Standard Voucher
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesnew york state standard deduction, nys voucher form, new york state standards for physical education, nys standard voucher fillable

Form Preview Example

 

AC92 (REV. 6/94)

 

SEE INSTRUCTIONS BEFORE COMPLETING

 

 

State

 

 

 

Of

STANDARD VOUCHER

 

 

New York

 

 

 

 

 

 

 

 

¹ Originating Agency (limit to 30 spaces)

 

Orig. Agency Code

Interest Eligible (Y/N)

 

 

 

 

 

 

 

Voucher Number

²P-Contract

Payment Date (MM/DD/YY)

OSC Use Only

Liability Date (MM/DD/YY)

³Payee ID

Additional

Zip Code

Route

Payee Amount

MIR Date (MM/DD/YY)

Payee Name (limit to 30 spaces)

IRS Code

IRS Amount

Payee Name (limit to 30 spaces)

Stat. Type

Statistic

Indicator-Dept.

Indicator-Statewide

Address (limit to 30 spaces)

Ref/Inv. No. (Limit to 20 spaces)

Address (limit to 30 spaces)

Ref/Inv. Date (MM/DD/YY)

City (Limit to 20 spaces)

(Limit to 2 spaces)

State

Zip Code

6Purchase Order No. and Date

Description of Material/Service

If items are too numerous to be incorporated into the block below,

use Form AC 93 and carry total forward.

Quantity

Unit

Price

Amount

⁷Payee Certification

I certify that the above bill is just, true and correct; that no part thereof has been paid except as stated and that the balance is actually due and owing, and that taxes from which the State is exempt are excluded.

Payee’s Signature in Ink

Title

 

 

 

 

Date

Name of Company

Total

Discount %

Net

FOR AGENCY USE ONLY

STATE COMPTROLLER’S PRE-

AUDIT

Merchandise Received

Date

Page No.

By

I certify that this voucher is correct and just, and payment is approved, and the goods or services rendered or furnished are for use in the performance of the official functions and duties of this agency.

Authorized Signature in Ink

DateTitle

 

 

 

 

CERTIFIED

 

Verified

FOR PAYMENT

 

 

OF

 

 

 

 

 

 

 

 

 

NET AMOUNT

 

Audited

 

 

 

 

 

 

 

 

Special Approval

By

 

 

(as Required)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Expenditure

 

 

 

 

Liquidation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cost Center Code

 

 

 

 

Accum

 

 

 

 

 

Dept

Cost Center

 

Var

Yr

Object

Dept

 

Statewide

Amount

Orig. Agency

PO/Contract

Line

F/P

Unit

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Distribution: Original to OSC with Copy to Agency/Department and Payee

Check if Continuation form is attached.

ABOVE FORM MUST PRINT ON ONE PAGE

NOTICE TO VENDORS OF SALES TAX EXEMPTION

This sheet may be retained by vendor and can be presented as proof of exemption from New York State and local sales taxes.

INSTRUCTIONS TO VENDORS PREPARING VOUCHERS

The numbered paragraphs below refer to the numbered blocks on the face of this form, which are to be completed.

Notice to vendors: Do not complete any blocks other than the following.

1.Originating Agency:

Insert name of State Department, Agency or institution being billed, as shown at the top of the Purchase Order.

2.P-Contract:

Enter here the P-Contract Number, if any, under which the purchase is made, e.g. P010966. Do not use hyphens or spaces.

NOTE: TO AVOID PROBLEMS WITH IRS, FOLLOW INSTRUCTIONS FOR BLOCKS 3 AND 4 CAREFULLY.

3.Payee I.D./Additional/Zip Code:

Enter your Federal Employer Identification Number (EIN). If you do not have an EIN, enter your Social Security Number. Do not use hyphens or spaces.

If you were assigned a Payee Additional Code by New York State, enter this in the box marked ‘Additional’. Enter your nine position ‘Zip+4’ in the adjacent block only if you have been assigned an Additional Code.

4.Payee Name and Address:

For individuals or sole proprietors, enter your name (exactly as it appears on your Social Security card) in the first Payee Name block. If there is a business name or DBA, Enter that information in the second Payee Name block.

Corporations, partnerships and tax exempt organizations should enter the name of the entity (exactly as registered with the Federal government) that corresponds to the EIN entered in Block 3.

Enter your proper mailing address conforming to U.S. Postal Standards. Include either your five-position zip code or your Zip+4 in your address.

5.Ref./Inv. No.:

Enter a reference number, invoice number, or other information. This information WILL APPEAR ON THE CHECK STUB and will identify the payment. Do not exceed 20 characters including letters, numbers, spaces, commas, etc. The check stub issued to you will contain the information you furnished in this block, and may be compared to this copy of the voucher, which you will detach and keep. Enter the corresponding reference/invoice date in the block below the Ref./Inv. No. block.

6.Description of Material/Service:

Enter all pertinent information required by the specific column headings. Extend calculations into “Amount” column.

VENDOR’S OPTION:

Any company that has its own invoice or bill form may refer to it by number or other identification in the Ref./Inv. No. block. In addition, write “See Invoice Attached” in the description block, and show the total in the “Amount” column. Attach invoices in duplicate to this voucher.

7.Payee Certification:

Clearly indicate the title of the person signing for the payee, e.g., sole owner, partner, treasurer, bookkeeper, billing clerk, etc.

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2. After filling in the last step, head on to the next step and enter all required particulars in these fields - Payee Certification I certify, Payees Signature in Ink Title, Date Name of Company, Total, Discount, Net, FOR AGENCY USE ONLY, STATE COMPTROLLERS PRE, AUDIT, Merchandise Received, Date, Page No, I certify that this voucher is, Authorized Signature in Ink, and Date Title.

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Be very attentive when filling in Date Title and Payees Signature in Ink Title, since this is the section where a lot of people make a few mistakes.

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