Massachusetts Payment Voucher Form PDF Details

In the world of financial transactions within the Commonwealth of Massachusetts, the Massachusetts Payment Voucher Form plays an indispensable role. Acting as an official request for the disbursement of funds, it encompasses several critical pieces of information, all aimed at ensuring a seamless and transparent financial operation. Departments or organizations within the state start by inputting their names, alongside essential document identifiers like the Department/Organization Number and Payment Voucher Date, to kick things off. As part of the vendor's certification, there's a commitment to verify that either goods were shipped or services rendered, a crucial step to validate the transaction. Further detail is provided through sections such as vendor name and address, document total, and payment references, each segment adding layers of accountability and clarity to the process. This form, a bridge between state entities and vendors, requires meticulous attention to detail, including descriptions of goods or services, unit prices, and amounts, ensuring every payment is backed by accurate and complete documentation. It isn't just a form; it's a testament to the state's commitment to upholding the highest standards of financial integrity and responsibility.

QuestionAnswer
Form NameMassachusetts Payment Voucher Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesyear 2019 mass dor payment voucher, massachusetts input, ma voucher input, ma payment voucher

Form Preview Example

PAYMENT VOUCHER INPUT FORM

Department/Organization Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Document ID

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Trans

 

Dept

 

R/Org

Number

PV Date

 

Acctg Prd

 

Budget FY

PV

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Action

(E)

 

 

Sch Pay Date

Off Liab Act

 

VENDOR'S CERTIFICATION

 

(M)

 

 

 

 

 

 

I certify that the goods were shipped or the service rendered

 

 

 

 

 

 

 

as set forth below

 

 

 

 

 

 

 

 

 

 

 

 

 

Ref Doc ID

 

 

 

 

 

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

 

 

 

 

 

 

(Please Sign In Ink)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Commonwealth of Massachusetts

Office of the Comptroller

Vendor Name and Address

Document Total

Payment Ref Number

Vendor Code

Emp

Reference Order

LN QTY

Description

Unit Price

Amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reference Doc ID

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LN

Trans

Dept

R/Org

 

Number

 

LN

Dept

Approp

Sub

Org

S/Org

Obj

Prog

 

TY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Proj/Cl/Grc

Actv

RPTG

Fund

BS Acct

Payment Reference Number

 

Description

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MSA#

 

Line#

 

Disc

 

 

 

Dates of Services

 

Quantity

Line Amount

 

 

 

I/D

P/F

 

 

 

 

 

 

 

 

 

 

to

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TO THE COMPTROLLER OF THE COMMMONWEALTH OF MASSACHUSETTS:

I hereby certify under penalties of perjury that all laws of the Commonwealth governing disbursementsof public funds and the regulations thereof have been compLIED with and observed.

Prepared By:

 

Title:

 

Date:

 

 

 

 

 

Entered By:

 

Title:

 

Date

 

 

 

 

 

 

 

The undersigned authorized signatory approving this document certifies that this document and any attachments are accurate and complete and comply with all applicable general and special laws and regulations.

INSTRUCTIONS TO VENDORS

-Fill in shaded area

-Direct inquires to state organization

Page of

Phone #

Approved By:

 

Title:

 

Date:

 

 

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