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Coverdell Forensic Science Improvement 2005-oN-BX Ol23
Progress Reports
Correspondence
ACH Vendor/Miscellaneous Payment Enrollment Form
Please provide the following financial institution information. All of this information is required to transfer
funds to your jurisdiction's account electronically.
Federal Program Agency
Agency Identifier
O]P Address
O]P Contact Person Name
Name
Miami Police Department
Address
400 NW 2nd Ave.
Miami, FL 33128
Contact Person Name
Mr. Joe Arriola
Agency Information
O]P Grant Number
2005-DN-BX-0123
Agency Location Code (ALC)
Telephone Number
Payee/Company Information
O]P Vendor Number
596000375
Telephone Number
(305) 250-5400
Financial Institution Information
*Mandatory fields
*Name:
https://grants.ojp.usdoj.gov/gLusextemal/ana/loaciAchForm.st
9/7/2005
ACH Financial Information Page 2 of 2
*Address Line 1:
Address Line 2:
.City:
j
*State:
Alabama 1.1
*Zip:
[ -Zip 4 1
*ACH Coordinator Name
I
*Phone
!
*Routing Number:
I
*Depositor Account Title:
*Depositor Account Number:
*Account Type:
Savings C Checking C Lockbox C
Lockbox Number:
I ........................
*Telephone Number of Authorized Official:
- _ I
https://grants.ojp.usdoj.gov/gmsexternal/anaIioadAchForm.st 9/7/2005
ACH VENDOR/MISCELLANEOUS PAYMENT OMB No, 1510-0056
ENROLLMENT FORM
This form is for Automated Clearing House (ACH) payments with an addendum record that contains payment -related information
processed through the Vendor Express Program. Recipients of these payments should bring this information to the attention of their
financial institution when presenting this for for completion.
PRIVACY ACT STATEMENT
The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All information collected on this form is
required under the provisions of 31 U.S.C. 3322 and 31 CFR210. This information will be used by the Treasury Department to
ransmit payment data, by electric means to vendor's financial institution. Failure to provide the requested information may delay or
revent the receipt of payments through the Automated Clearing House Payment System.
AGENCY INFORMATION
FEDERAL PROGRAM AGENCY
Office ofJustice Programs
AGENCY IDENTIFIER AGENCY LOCATION CODE (ALC):
OJP 15-04-0001
ADDRESS
810 Seventh Street, NW Attn: Office of the Comptroller Control Desk
OJP Grant Number/s:
Washington D.C. 20531
CONTACT PERSON NAME
Office of the Comptroller Customer Service Center
ADDITIONAL INFORMATION
NAME:
ADDRESS:
TELEPHONE NUMBER
L (800)458-0786
PAYEE/COMPANY INFORMATION
OJP Vendor Number:
CONTACT PERSON NAME: 1 TELEPHONE NUMBER:
NAME:
ADDRESS:
FINANCIAL INSTITUTION INFORMATION
ACH COORDINATOR NAME:
NINE -DIGIT ROUTING TRANSIT NUMBER:
DEPOSITOR ACCOUNT TITLE:
DEPOSITOR ACCOUNT NUMBER:
TYPE OF ACCOUNT: k CHECKING
TELEPHONE NUMBER:
SAVINGS LOCKBOX
SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL:
(Could be the same as ACH Coordinator)
L
NSN 7540-01-274-9925
LOCKBOX NUMBER:
TELEPHONE NUMBER:
388110;
AGENCY COPY
SF388t (Rev. 1290)
Prescribed by Department of
Treasury