Resident Personal Funds Withdrawal Slip

IDAHO DEPARTMENT OF CORRECTION
Resident Personal Funds Withdrawal Slip
Updated 06/24/2026
114.024 Resident Personal Funds Withdrawal Slip v2
Page 1 of 1

Date: Voucher Number: HQ
Balance Before Draw: Facility/Housing Unit:

Resident Trust Account Withdrawal Details
Key Description Qty Per Total
Price
Key Description Qty Per Total
Price

Please charge to my resident trust account the sum of $

I authorized the amount charged to be paid to:

(Payee) (Street Address)

(City, State, and Zip Code) (For the Purpose of)

(Resident’s Printed Name) (Resident’s Signature) (Resident’s IDOC Number)

The resident’s trust account has been charged in the amount authorized:
(Approving Official’s Signature and Associate ID Number)
Pink copy (resident maintains)
Original and Yellow copy to approving official (after completing, yellow copy returned to resident)

This is an exact model and must be produced on three (3)-part NCR paper.