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X No.: Phone No: Fiscal Officer E-Mail Address: The employees whose signatures appear below are authorized to approve and release expenditure documents and transactions and/or certify payroll for this agency, department or institution. To the Comptroller: DOA Payroll Service Bureau (Participating Agency) Yes No As a participating agency, the employees whose signatures appear on Form PSB-01-001, Authorized Parties for CIPPS Payroll Certification Entry, are authorized to enter the CI.

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