Attach supporting documentation
to the back of this form / State of Iowa / JV1R
BUDGET FY / Correcting Journal Voucher
Reverted / Split Dollars SAB / DOCUMENT NUMBER
DATE / ACCTG PERIOD
Doc Description: / Reversal Date:
Doc Total Debits: / $ 0.00 / Doc Total Credits: / $ 0.00
Line Group: / 0001 / Event Type:
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FUND / SUB DEPT UNIT / SUB APPR OBJT / SUB REV / SUB BSA / SUB
OBSA / SUB DEPT OBJ DEPT REV LOC / SUB ACTY / SUB FUNC / SUB REPT / SUB
TASK / SUB TASK ORD MJR PRG PROGM PHASE PRG PERIOD
Acct Line: 0002 BFY: Period: Event Type: Post Code:
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FUND / SUB DEPT UNIT / SUB APPR OBJT / SUB REV / SUB BSA / SUB
OBSA / SUB DEPT OBJ DEPT REV LOC / SUB ACTY / SUB FUNC / SUB REPT / SUB
TASK / SUB TASK ORD MJR PRG PROGM PHASE PRG PERIOD
Acct Line: 0003 BFY: Period: Event Type: Post Code:
Debit Amt: Credit Amt:
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FUND / SUB DEPT UNIT / SUB APPR OBJT / SUB REV / SUB BSA / SUB
OBSA / SUB DEPT OBJ DEPT REV LOC / SUB ACTY / SUB FUNC / SUB REPT / SUB
TASK / SUB TASK ORD MJR PRG PROGM PHASE PRG PERIOD
Acct Line: 0004 BFY: Period: Event Type: Post Code:
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Line Desc:
FUND / SUB DEPT UNIT / SUB APPR OBJT / SUB REV / SUB BSA / SUB
OBSA / SUB DEPT OBJ DEPT REV LOC / SUB ACTY / SUB FUNC / SUB REPT / SUB
TASK / SUB TASK ORD MJR PRG PROGM PHASE PRG PERIOD

JV1R Created by: Date Created:

State of Iowa / JV1R Doc # / 0 / Dept Name:
Doc Description: / Reversal Date:
DocTotal Debits: / $ 0.00 / Doc Total Credits: / $ 0.00
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Line Group Description:
Acct Line: 0001 BFY: Period: Event Type: Post Code:

Debit Amt: $ Credit Amt: $

REF: Vendor Line: Commodity Line: Actg Line:

Line Desc:

FUND / SUB DEPT UNIT / SUB APPR OBJT / SUB REV / SUB BSA / SUB
OBSA / SUB DEPT OBJ DEPT REV LOC / SUB ACTY / SUB FUNC / SUB REPT / SUB
TASK / SUB TASK ORD MJR PRG PROGM PHASE PRG PERIOD

Acct Line: 0002 BFY: Period: Event Type: Post Code:

Debit Amt: $ Credit Amt: $

REF: Vendor Line: Commodity Line: Actg Line:

Line Desc:

FUND / SUB DEPT UNIT / SUB APPR OBJT / SUB REV / SUB BSA / SUB
OBSA / SUB DEPT OBJ DEPT REV LOC / SUB ACTY / SUB FUNC / SUB REPT / SUB
TASK / SUB TASK ORD MJR PRG PROGM PHASE PRG PERIOD

Acct Line: 0003 BFY: Period: Event Type: Post Code:

Debit Amt: $ Credit Amt: $

REF: Vendor Line: Commodity Line: Actg Line:

Line Desc:

FUND / SUB DEPT UNIT / SUB APPR OBJT / SUB REV / SUB BSA / SUB
OBSA / SUB DEPT OBJ DEPT REV LOC / SUB ACTY / SUB FUNC / SUB REPT / SUB
TASK / SUB TASK ORD MJR PRG PROGM PHASE PRG PERIOD

Acct Line: 0004 BFY: Period: Event Type: Post Code:

Debit Amt: $ Credit Amt: $

REF: Vendor Line: Commodity Line: Actg Line:

Line Desc:

FUND / SUB DEPT UNIT / SUB APPR OBJT / SUB REV / SUB BSA / SUB
OBSA / SUB DEPT OBJ DEPT REV LOC / SUB ACTY / SUB FUNC / SUB REPT / SUB
TASK / SUB TASK ORD MJR PRG PROGM PHASE PRG PERIOD

JV1R 2