Memorandum To: Disbursement Services, 104 Airport Drive CB#1220
From: Name: Email:
Department: Dept #: Phone#:
Address: CB#: Date:
Request to Liquidate Encumbrance from:
Ledger: Account#: Object Code:
Requisition #: Check Req (K)#: Purchase Order #
Travel Authorization#: Amount $:
Explanation of Request: