Attachment_E,_SFT_Transmittal_Example.pdf
PDF 38 KB Posted
- Attached to
- HOC Financial Support Services Federal contract opportunity
- Solicitation number
- 86548B18R00001
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Attachment E, SFT Transmittal Example
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Text version
Created Date: 10/11/2017
Updated By: HXXXXX1
Updated 11/01/2017 Date:
Pay By Date' 11/08/2017
Amount Paid: 2,300.69
Date Paid:
Remit Address:
10/25/2017
ROCK ISLAND COUNTY
COLLECTOR
PO BOX 3277
ROCK ISLAND IL 61204
Tax Transmittal
Tax Authority ILROCKI500 Transmittal: SFT3A1800010 Created By. HXXXXXX NAID Someperson
Name: ROCK ISLAND Transmittal 10/11/2017 TAX Date:
COLLECTOR
Check/EFT Check Transmittal Tax Flag: Type:
Tax Type: RE Total 2,300.69 Amount:
Tax Year: 2016 Total 0.00 Discount Amount:
Tax Period: 04 Total Penalty o.00 Amount:
Tax From: 10/01 Total Interest o.00 Amount:
Tax To: 12/31 Total Net 2,300.69 Amount:
Contract 3A
Area:
Invoice Type:
Locator: 00010
Notes:
No of Line 5
Items:
Status: CC
Status Date: 11/01/2017
Prepare/Reviewer/Approver Certification -
Disbursements are being made under U.S. Department of Treasury delegation of authority based upon this certification.❑To the best of my knowledge, all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
Preparer's Signature Date (mm/dd/yyyy) Title and Phone
Reviewer's Signature Date (mm/dd/yyyy) Title and Phone
Approver's Signature Date (mm/dd/yyyy) Title and Phone
Section IV: For HUD Certifying Officer's Use Only -
CID CID CID CID ElPursuant to authority vested in me, I certify that this transmittal and its attachments are correct and p payment.
Certifying Officer's Signature Date (mm/dd/yyyy) Title and Phone
H56750 Text Box PWS Attachment E HOC Financial Support Services Example SFT Transmittal
Detail
Seq
Case Tax Account # Total Discount
Amount
Penalty
Amount
Respon-sibility
Interest
Amount
Net
Amount
137-XXXXXX
0835200008 785.93 0.00 0.00
0.00 785.93
0835200009 33.38 0.00 0.00
0.00 33.38
1611300001 887.37 0.00 0.00
0.00 887.37
0833308008 50.48 0.00 0.00
0.00 50.48
0930219014 543.53 0.00 0.00
0.00 543.53
Total Due 2,300.69
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