State of Florida Department of Financial Services Division of Treasury Bureau of Management Quarterly Report of Agency Clearing and Revolving Funds Agency Name: Address: Quarter Ending: Clearing Account Revolving Account Account Bank Name and Amount Dep Amount Name Address Cash Balance into Treasury Authorized Cash Balance Totals Division of Treasury/Bureau of Funds Management Cash Management Section 200 East Gaines Street Tallahassee, FL 32399-0344 Fax: (850) 413-2724
State of Florida Department of Financial Services Division of Treasury Bureau of Management Quarterly Report of Agency Clearing and Revolving Funds Agency Name: Address: Quarter Ending: Clearing Account Revolving Account Account Name Bank Name and Address Cash Balance Amount Dep into Treasury Amount Authorized Cash Balance Totals Division of Treasury/Bureau of Funds Management Cash Management Section 200 East Gaines Street Tallahassee, FL 32399-0344 Fax: (850) 413-2724
DFS-J2-2188.docx