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DISBURSING OFFICE COLLECTION VOUCHER NO.

CASH COLLECTION VOUCHER

RECEIVING OFFICE COLLECTION VOUCHER NO. ACTIVITY (Name and location) (Include ZIP Code)

THEIR ADDRESS

RECEIVED AND FORWARDED BY (Print name, title and signature) DATE

Their address and phone number with the area code 2/24/2006

ACTIVITY (Name and location) (Include ZIP Code)

DFAS-IN DNO DEPT 3400 8899 EAST 56TH STREET INDIANAPOLIS IN 46249-3400

DISBURSING OFFICER (Printed name, title and signature) DISBURSING STATION SYMBOL NO. DATE RECEIVED SUBJECT TO COLLECTION

JO SEPH A MYRDA Director

Directorate for Centralized Disbursing

PERIOD:

DATE

REC'D

NAME OF REMITTER DESCRIPTION OF REMITTANCE

FROM

5570

TO

`

AMOUNT ACCOUNTING

DETAILED DESCRIPTION OF

PURPOSE FOR WHICH COLLECTIONS WERE RECEIVED

Trademark Licensing Refunds

21F 3875.0026 $10,000.00 FSN 023185

EXAMPLE OF DD1131

FY= F APC= 1500RA DPI= RA EOR=0000 FSN= 023185

TOTAL

$10,000.00 *

REPLACES EDITION OF 1 APR 56 WHICH IS OBSOLETE

Form approved by Comptroller General, U.S. 24 Janurary 1958

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INTRODUCTION
DD Form 1131, Cash Collection Voucher, December 2003
sample 1131.pdf