U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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     Indian Health Manual

Circular Exhibit 03-03 A


ELECTRONIC VERSION OF THE JOURNAL VOUCHER-COMPLETED

SAMPLE

Date __________________
JV No. JV0 2450144

--------------------------------------------------------------------------------

TC Appropriation FY AltA/wSsa Doc. No. CAN OC CC Debit Credit

237 751/20390 2002 61045.06 1022014700 J45MR22 350 $12,000.00

Appropriation Total $12,000.00

190 751/20390 2003 61045.06 1022014700 J45MR22 350 $12,000.00

Appropriation Total $12,000.00

Prepared by:_________________________ Approved by: ___________________________ Accountant Supervisor/PMO/SUD

Circular Exhibit 2003-03-A

JOURNAL VOUCHER - ELECTRONIC VERSION

Date __________________
JV No. ________________

--------------------------------------------------------------------------------

TC Appropriation FY AltA/wSsa Doc. No. CAN OC CC Debit Credit

Appropriation Total:______________

TC Appropriation FY AltA/wSsa Doc. No. CAN OC CC Debit Credit

Appropriation Total:______________

Prepared by:_________________________ Approved by: ___________________________ Accountant Supervisor/PMO/SUD


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