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Please check the purpose(s) for which you are submitting this form:  FORMCHECKBOX  Recording Expense Index code to expense:  FORMTEXT      Account code: 62868A FORMCHECKBOX  Replenishing FundIf replenishing, indicate: $ FORMTEXT      * Set amount fund $ FORMTEXT       ** Revolving fund $ FORMTEXT       FORMCHECKBOX  Closing FundIf closing fund, amount returned: $ FORMTEXT       * Set amount fund (maintaining amount of original request in fund) ** Revolving fund (varying the amount maintained in fund)   F.45   ƹ~ocT~A~%jhP$hmPCJOJQJUaJhP$h J5CJOJQJaJh_CJOJQJaJhP$h_CJOJQJaJhP$hmPCJOJQJaJhy24h_CJOJQJaJhmP5CJOJQJaJhdh_5CJOJQJaJhg/5CJOJQJaJh0CJOJQJaJhPQhg/CJOJQJh ECJOJQJhPQh E5CJOJQJjhU45 zzzmzzz .Z/Z^gdmP.Z/Zgd_.Z/Zgd EVkd.$$Ifl0& t644 laytPQ$$.Z/ZIfa$gdUp $.Z/ZIfgdPQ   4 6 J L N X Z f n    " H J ^ ` b l n ֽֽ֮֮֮֮sֽ֮֮]ֽ֮Qh J5CJOJQJaJ+jhP$hmPCJOJQJUaJ+j`hP$hmPCJOJQJUaJhP$hP$CJOJQJaJ+jhP$hmPCJOJQJUaJhP$hmPCJOJQJaJ0jhP$hmPCJOJQJUaJmHnHu%jhP$hmPCJOJQJUaJ+jthP$hmPCJOJQJUaJ & ( * F H J p r ǻ娙t^E9h8nCJOJQJaJ0jh[hP$CJOJQJUaJmHnHu+jh[hP$CJOJQJUaJh[h J5CJOJQJaJ+jPh[hP$CJOJQJUaJh[hP$CJOJQJaJ%jh[hP$CJOJQJUaJh)8CJOJQJaJhP$hP$CJOJQJaJhP$h J5CJOJQJaJhP$CJOJQJaJhP$hg/CJOJQJaJ ( p r @ <gkd> $$IflF '@  t6    44 la<yt[ $.Z/ZIfgd[.Z/Zgd_    x z *,.8:>@\^`ޙޙmޙW+j h[hP$CJOJQJUaJ+j h[hP$CJOJQJUaJ+j h[hP$CJOJQJUaJ0jh[hP$CJOJQJUaJmHnHu+j h[hP$CJOJQJUaJ+j h[hP$CJOJQJUaJ%jh[hP$CJOJQJUaJh[hP$CJOJQJaJ"<>| $.Z/ZIfgd[gkd $$IflF '@  t6    44 la<yt[""""ֽ֮~scNcLc4N.j3 h[h J5>*CJOJQJUaJU(jh[h J5>*CJOJQJUaJh[h J5>*CJOJQJaJh[h J5OJQJ(jh[h J5OJQJUmHnHuh[h&,OJQJh&,OJQJh J5OJQJh[hP$CJOJQJaJ0jh[hP$CJOJQJUaJmHnHu%jh[hP$CJOJQJUaJ+jX h[hP$CJOJQJUaJv""~~~n$$.Z/ZIfa$gd[ $.Z/ZIfgd[ .Z/Z^gd&,gkd $$IflF '@  t6    44 la<yt[ ORMTEXT       Signature of Principal InvestigatorDate Department Chair, Dean, or Director Authorization I certify that I have reviewed the human subjects payment records and there were  FORMTEXT       subjects that received $ FORMTEXT       each for this project. The total amount disbursed was $ FORMTEXT      .   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