Procedure
REVISION DATE CHAPTER TITLE CHAPTER NO.
ADMINISTRATIVE MANUAL
MILWAUKEE COUNTY
11-13-02 Financial & Management
Accounting
7
ORIG ISSUE DATE SECTION TITLE
01-01-77 Check Request
SECTION NO.
7.05
7.05 CHECK REQUEST, FORM NO. 502
A sample of the manual pre-numbered multi-part form follows this section as Appendix "A" and is obtainable from Document Services. A sample of the electronic form follows this section as Appendix "B" and is available from the Lotus Notes' Forms Database. The electronic form uses a pre-numbered sticker, which is available from
Document Services. When ordering forms, state specifically which item you are requesting - the three-part manual pre-numbered form or pre-numbered stickers for use with the electronic form.
(1) PURPOSE. To provide a uniform procedure for paying County obligations when there is no outside invoice or source document available. The form should not be used for the following type of documents:
- Utilities (code and approve invoice)
- Construction (Certificate of Payment)
- Travel (Travel Expense form)
- Mileage (Mileage form)
- Petty Cash (Petty Cash Form)
- Court Ordered Payments
- Worker's Compensation (Medical Bills Special Form)
- Purchasing Documents (PD, PG, PC & SC)
A separate form is required for each payee, except for witness fees, tuition fees, land purchases, employee worker's compensation and refunds. If the request is for a payment out of a trust fund, the proper fund number and its associated balance sheet account code must be used. In all other cases, the fund, agency, low org. unit and object/revenue source code will be used.
(2) AUDIT CONTROL. The Check Request forms are pre-numbered for control purposes. Also available are prenumbered labels to be placed in the upper right-hand corner of the electronic Check Request form found in the
Lotus Notes' Forms Database. In case a manual form or label is ruined, mark all copies "VOID", and retain them in numerical sequence for audit purposes.
(3) ORIGIN. Origination of this form is the responsibility of the department administrator.
(4) PREPARATION.
(a) Voucher Number Agency. Fill in your agency number for reference purposes.
(b) Date of Record.
(c) Accounting Period. Month and year this expenditure relates to.
(d) Budget Fiscal Year. Budget year this expenditure relates to.
(e) Date Check is Requested. Enter the date on which the check is required for payment. This is the date the check will be available for mailing. This should be the mandatory or critical due date only, otherwise leave blank.
(f) Document Total. Indicate the total payment.
(g) Vendor Number. Enter the Advantage System vendor number, if known.
(h) Name and address of payee. Enter the name and address of the payee on the lines provided for this purpose.
(i) Account distribution. There must be as many lines as there are account distributions and the sum of the amounts must equal the document total. Based on the type of payment, at a minimum enter the following information:
1. Expenditure - Fund, Agency, Org. Unit and Object.
2. Revenues- Fund, Agency, Org. Unit and Revenue Source.
7.05-1

Procedure
REVISION DATE CHAPTER TITLE CHAPTER NO.
ADMINISTRATIVE MANUAL
MILWAUKEE COUNTY
11-13-02 Financial & Management
Accounting
7
ORIG ISSUE DATE SECTION TITLE
01-01-77 Check Request
SECTION NO.
7.05
3. Balance Sheet or Trust – Fund and Balance Sheet Account
4. Enter additional programmatic account distribution information if needed for revenue and expense accounts including Activity, Function, Job Number and Reporting Category.
5. Enter Project Number if charges are to a capital project (Agency 120).
(j) Amount. Enter the amount for which the account distribution line is to be charged.
(k) Invoice No(s). Enter the invoice number of any attached documents. This number will appear on the check stub.
(l) Remarks. This space may be used for explanations.
(m) Contractual information. This section is completed if a check is used as payment on a contract.
1. Encumbered contract on file. Check yes or no.
2. Amount of this payment. Enter amount of check request.
3. Contract Encumbrance Document: Enter PO document number for contract.
4. Contract amount. Enter the total amount of the contract, including any adjustments that have been made.
5. Payment to date. Enter the total amount that has been paid on the contract up to the date of preparation of this request.
(n) Prepared by. Enter the name of the person responsible for preparing the form.
(o) Approved by. Department Head or authorized representative (must have an Authorized Signature Card on file) must sign before submittal to Accounts Payable.
(5) DISTRIBUTION
(a) Manual Form: Part 1 (White). Forward to Fiscal Affairs (Department of Administration) – Accounts
Payable.
Part 2 (Canary). Extra copy to be used at the user's discretion.
Part 3 (Pink). Retained in the originating department and filed in numerical sequence.
(b) Electronic Form: Attach pre-numbered white label to the top of the document. Make two photocopies and distribute in the same manner as the manual form. The original (with white label) should be forwarded to Fiscal Affairs (Department of Administration) – Accounts
Payable.
7.05-2

Procedure
ADMINISTRATIVE MANUAL
MILWAUKEE COUNTY
REVISION DATE
11-13-02
CHAPTER TITLE
Financial & Management
Accounting
CHAPTER NO.
7
ORIG ISSUE DATE SECTION TITLE
01-01-77 Check Request
SECTION NO.
7.05
7.05-Appendix A

Procedure
ADMINISTRATIVE MANUAL
MILWAUKEE COUNTY
REVISION DATE
11-13-02
CHAPTER TITLE
Financial & Management
Accounting
CHAPTER NO.
7
ORIG ISSUE DATE SECTION TITLE
01-01-77 Check Request
SECTION NO.
7.05
9
10
7
8
11
12
3
4
1
2
5
6
No. X Place pre-numbered sticker here
C HEC K REQ UEST
MILW AUKEE COUNTY
502 R11
Re fe r to C ha p te r 7, Se c tio n 7.05 C o un ty A d m in istra tiv e M a nua l
Date of Record
4b
USE O NLY IF THERE IS NO O UTSIDE SO URC E DO C UM ENT
Voucher Number
Accounting Period
DA TE C HEC K IS REQ UIRED*
Document
PV
4c
Agency
4a
Number
Bud FY
Doc Total
4d
4e 4f
*M a nd a to ry, C ritic a l Due Da te s O nly, O the rw ise Le a ve Bla nk
VENDO R NUM BER, NAME AND ADDRESS O F PAYEE (Atta c h list if ne c e ssa ry)
Vendor Number
4g
4h Name
Address 1 4h
Address 2 4h
City 4h State 4h Zip 4h
Line AC C OUNT DESC RIPTIO N
AC C O UNT DISTRIBUTIO N
Fund
Ba l Sht
Ac c ount Age nc y O rg. Unit Ac tivity Func tion O bje c t Re v Src
I I I I I I
4i1 4i3
I I
4i1
I I I I I I
4i1 4i4
Proje c t or
Job
Re pt
Num be r Ca te gry
I I I I l I I l I I l I
4i4 4i1 4i2 4i4
I l I l I l I
4i4 4j
AM OUNT
Invoic e No(s): REM ARKS: 4l
4k
4k
Enc um b e re d C o ntra c t o n File ?
A m o unt o f This Pa ym e nt: $
4m1 Yes
No
4m1
4m4
Pre pa re d by 4n
PA RT 1 (White Stic ke r) - DEPT O F A DM INISTRATIO N-FISC AL
C O NTRAC T INFO RM ATIO N
C o ntra c t Enc um b ra nc e No .
Document
PO
Agency
4m2 4m2
Number
C o ntra c t A m o unt: (Inc lud ing A d justm e nts) $
Pa ym e nts to Da te : $
4m3
4m5
Referenced Document
(if applicable)
Approve d by
Document Agency Number
4o
(De p t. He a d o r A u tho rize d Re p re se n ta tive )
COPY - ORIGINATING DEPT. - RETAIN IN NUMERICAL ORDER FOR AUDIT
7.05-Appendix B

Procedure
ADMINISTRATIVE MANUAL
MILWAUKEE COUNTY
REVISION DATE
11-13-02
CHAPTER TITLE
Financial & Management
Accounting
CHAPTER NO.
7
ORIG ISSUE DATE SECTION TITLE
01-01-77 Check Request
SECTION NO.
7.05
7.05-Appendix B