ATTACHMENT VI

TEBPF Journal

TO: Central Accounts Payable Division, 30 Trinity Street, Hartford, CT 06106
(1)AGENCY NO.		(2) BATCH NUMBER		(3) NO. OF DOC.	(4) BATCH AMOUNT
1155		80,000		1	300,000.00
(5) SUBMITTED  BY (Agency Name)  Dept. of Housing					(6) TELEPHONE NUMBER - BUSINESS OFFICE xl234
(7) PAYEE	(8) PAYEE LIST		(9)  PURCHASE ORDER NUMBER	(10) REQ. FOR RES.OF FUNDS OR TRAV. AUTH. NO.	(11)  AMOUNT OF INVOICE
TAX-EXEMPT BOND PROCEEDS FUND Deposit					300,000.00
NO
CHECK			REQUIRED
CHECK THE APPROPRIATE BOX   TAPE   ONLINE   XX CENTRALLY
AGENCY CERTIFICATION
As a duly authorized agent of the above named agency, I do hereby certify that to the best of my knowledge the amount shown above equals the totals of the invoices and/or payments submitted herewith for payment and are valid claims against the state; no commission, bonus or reward has been promised or received or is expected on account thereof, by an official or employee of the State; and the expenditures are authorized and properly chargeable to appropriations as indicated.
(13) AUTHORIZED SIGNATURE (agency head)			(14) CONTACT PERSON		(18) DATE
DISTRIBUTION: Original - Comptroller Part 2 - Agency

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