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California State University, Long BeachCalifornia State University, Long Beach

Gifts and Awards Payment Request

General Instructions

  1. Gifts and Awards Policy Web Links Gifts to Employees Gifts to Non-Employee
  2. Review the Detailed Instructions for Gifts and Awards Payment Request Form
  3. Complete the form and use the button below to display a printer friendly version.
  4. Print the "Printer Friendly Version" of the form.
  5. Return the completed form, receipts, and supporting documentation to:

    LBCMP/LBFDN/LB49R - University Controller's Office - Accounts Payable, Foundation Building Suite 280 (MS-9901), 6300 State University Drive, Long Beach CA 90815-4680

  6. Google Chrome recommended when completing the form.
Fields with * are required.

Request/Invoice Details

BUSINESS UNIT
  • LBCMP = Campus
  • LBFDN = Research Foundation
  • LB49R = Philanthropic Foundation
*Select Business Unit that will be making payment.
REQUEST DETAIL (mm/dd/yy)

INVOICE DETAIL (mm/dd/yy)

$

Payee/Supplier Information

*PAYEE/SUPPLIER TYPE

TAX FORM #204

PAYEE/SUPPLIER INFORMATION (see Direct Payment Form)

*GIFT AND AWARD TYPE

Cost Gift or Award Description Gift or Award Recipient Presenting University Official & Title Location Date
Chartfield Information
Business Unit *Amount *Account *Fund Dept ID Program Class Project
$
$
$
Payee Total $

Justification of Award or Gift provided on behalf of University interests
SPECIAL REQUEST DISPOSITION

STATEMENT OF PAYEE/REQUESTER RESPONSIBILITIES

(If requesting employee or student reimbursement, his/her signature is required)

I certify that this expenditure is reasonable and necessary for the department's operations and the University's mission.

Payee/Requester Signature

STATEMENT OF APPROPRIATE ADMINISTRATOR/APPROVER RESPONSIBILITIES

I certify that the funds are available for this expenditure and that this expenditure is reasonable and necessary for the department's operations and the University's mission

Appropriate Administrator/Approver Signature

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