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NOTICE TO ATTORNEY GENERAL’S OFFICE

ADVISED PAYMENT

 

 

Client Agency:                                                                                                                                 

 

Debtor Name:                                                                                                                                 

 

OAG Account Number:                                                                                                                  

 

Type of Payment Instrument:      _____       Personal Check

 

                                                      _____       Postal Money Order

 

                                                      _____       Other Money Order                                         

                                                                                                                 (Financial Institution)

                                                      _____       Official Bank/Teller’s Check                          

                                                                                                                            (Bank Name)

                                                      _____       Cash

 

                                                      _____       Debit Card

 

                                                      _____       Credit Card

 

                                                      _____       Certified Check                                               

                                                                                                          (Financial Institution)

                                                      _____       ACH Transfer

 

                                                      _____       Web Payment

 

 

 

Instrument Number:                                                                                                                        

 

Amount of Payment:                                                                                                                       

 

Date on Payment Instrument:                                                                                                        

 

Date Payment Received by Client Agency: