SF1049

Public Voucher for Refunds - Table Format

Agency
GSA
Revision
Rev. 09/1973
Fillable fields
64
Pages
1
Official source
GSA form page
Checked
October 20, 2026
Fill SF1049 online
Page 1 of form SF1049

Standard Form 1049 (SF 1049): Public Voucher for Refunds (Table Format)

Standard Form 1049 (SF 1049), Public Voucher for Refunds, is a one-page voucher that lists deposits received from a payee or depositor, the charges applied against them and the balance due. GSA hosts a copy in its forms library, where its page lists it as Public Voucher for Refunds - Table Format with a current revision date of 09/1973.

The downloaded PDF is a scanned image. Its header names Standard Form 1049, but the small print under it is hard to read in the scan. The page has a voucher header, a Statement of deposit(s) received and applied table, a certification that the sum shown is due said depositor, an approval line and a Refund by block.

The PDF prints no instructions, filing address or privacy notice. You can fill it out free in your browser on this page and download the result without an account.

What's on SF 1049

Voucher header

Voucher No., Schedule No., Voucher prepared, a U.S. line, Appropriation or Fund, and a PAID BY box.

To and Address

THE UNITED STATES, Dr., followed by a rounded box for the name and address.

Statement of deposit(s) received and applied

A Contract No. and a Date above a table with columns for date of deposit, receipt number, articles or services, amount deposited, applied charges, balance due depositor and notations.

Total row

A TOTAL row under the amount deposited, applied charges, balance due depositor and notations columns.

Certification and approval

I certify that the above statement of deposit(s) of the payee or depositor named is correct and that the sum of a stated amount is due said depositor, then Approved and refund authorized for.

Refund by

Check No.; Cash, with an amount, a date and the signature of payee; or Other method.

How to complete SF 1049

  1. 1

    Fill in the header

    Enter the voucher number, schedule number, the Voucher prepared details, the U.S. line and the appropriation or fund.

  2. 2

    Enter the payee or depositor

    Write the name and address in the To and Address box.

  3. 3

    List each deposit

    Add the contract number and date, then one row per deposit with its receipt number, a description including detail of applied charges, and the amounts.

  4. 4

    Total the columns

    Enter the totals on the TOTAL row of the table.

  5. 5

    Certify and approve

    Enter the sum due said depositor in the certification, then sign the approval line marked Sign original only and add a title.

  6. 6

    Record the refund

    Show the check number, or the cash amount and date with the signature of payee, or another method.

Why fill Form SF1049 on indox

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Where it goes and what the form says

Where it goes

The PDF prints no filing address or routing instructions. The To and Address box holds the payee or depositor's name and address.

A scanned copy

The downloaded PDF is a scanned image. The lines under Standard Form 1049 in the header and the footnote at the bottom are hard to read, so this page does not quote them.

Revision

GSA's page gives 09/1973 as the current revision date and lists no authority or regulation.

Related forms

Who uses SF 1049?

  • The office preparing the voucher

    The header has a Voucher prepared line, a U.S. line and an Appropriation or Fund line, next to a voucher number and schedule number.

  • The payee or depositor

    Under THE UNITED STATES, Dr., a To and Address box holds the name and address. The certification refers to the payee or depositor named.

  • The certifying and approving official

    The certification and the line Approved and refund authorized for lead to a signature line marked Sign original only and a Title line.

  • The payee of a cash refund

    When the refund is paid in cash, the Refund by block has a line for the signature of payee.

The form prints no instructions. These are the parties its blocks name.

Official sources and the blank

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Questions about Form SF1049

Who issues SF 1049?

The header names Standard Form 1049, but the lines beneath it are hard to read in the scanned PDF. GSA hosts a copy in its forms library and lists 09/1973 as the current revision date.

How is SF 1049 different from SF 1047?

GSA's pages list SF 1049 as the table format and SF 1047 as the letter format of the Public Voucher for Refunds. SF 1049 lists deposits in a table. SF 1047 states one deposit in a printed sentence with amount lines.

What does the certification on SF 1049 say?

It reads: I certify that the above statement of deposit(s) of the payee or depositor named is correct and that the sum of a stated amount is due said depositor.

How can the refund be paid?

The Refund by block lists a check number; cash, with an amount, a date and the signature of payee; or another method.

Which copy is signed?

The approval signature line is marked Sign original only.