SF1147

Request for Issuance of Replacement Check Due to Error in Name and/or Designation of Payee

Agency
GSA
Revision
Rev. 5/1995
Fillable fields
15
Pages
1
Official source
GSA form page
Checked
October 20, 2026
Fill SF1147 online
Page 1 of form SF1147

Standard Form 1147 (SF 1147): Request for Replacement Check Due to Error in Name of Payee

Standard Form 1147 (SF 1147), Request for Issuance of Replacement Check Due to Error in Name and/or Designation of Payee, is a Department of the Treasury form, Rev. 5/1995, with the reference I TFRM 4-6000 as printed. GSA hosts a copy in its forms library.

The one-page request is addressed To Disbursing Office. It lists the check number, date, amount, symbol number and voucher number, the name and/or designation shown on the check, and the correct name and/or designation. An authorized certifying officer certifies that the correct name and/or designation of the payee is as shown and that the amount stated is due the payee, and authorizes a replacement check for delivery in the usual manner. A block at the bottom is for the disbursing officer. The form says the previous edition is not usable.

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Top of page 1 of Standard Form 1147 (SF 1147): Request for Replacement Check Due to Error in Name of Payee, as printed by GSA

What's on SF 1147

To Disbursing Office and date

The heading addresses the request to the disbursing office, with a date line.

Check details

Check No., Date, Amount, Symbol No. and Voucher No. of the check.

Name on the check

Name and/or designation on check: the payee name as it appears on the check.

Correct name

Correct name and/or designation of the payee.

Certification and office

The certification, administrative office, location, signature of authorized certifying officer and name of authorized certifying officer, typed or printed.

Disbursing officer block

Replacement check issued as authorized, a control number, a date and the line For Disbursing Officer.

How to complete SF 1147

  1. 1

    Date the request

    Enter the date at the top of the request addressed To Disbursing Office.

  2. 2

    Describe the check

    Enter the check number, date, amount, symbol number and voucher number.

  3. 3

    Show both names

    Enter the name and/or designation as shown on the check, then the correct name and/or designation.

  4. 4

    Identify the office

    Enter the administrative office and its location.

  5. 5

    Certify and sign

    The authorized certifying officer signs and types or prints their name, certifying the correct payee and the amount due and authorizing a replacement check.

  6. 6

    Disbursing office action

    The disbursing officer records Replacement check issued as authorized with a control number and date.

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Where it goes and what the form says

Where it goes

The request is addressed To Disbursing Office. The PDF prints no street address.

Delivery of the replacement

The certification authorizes issuance of a replacement check as indicated, for delivery in the usual manner.

Edition

The form prints Standard Form 1147, Rev. 5/1995, Department of the Treasury, I TFRM 4-6000, and says Previous edition is not usable. GSA's page lists a current revision date of 03/1982.

What the PDF does not print

No instructions, OMB number or Privacy Act statement. GSA's page lists no authority or regulation.

Related forms

Who uses SF 1147?

  • The administrative office

    The office making the request is named with its location in the Administrative Office and Location blocks.

  • An authorized certifying officer

    Signs the certification and types or prints their name. The certification says the correct name and/or designation is as shown and the amount stated is due the payee.

  • The disbursing office

    The request is addressed To Disbursing Office, and the certification authorizes issuance of a replacement check as indicated.

  • The disbursing officer

    Completes the block Replacement check issued as authorized, with a control number and date, on the line For Disbursing Officer.

  • The payee

    The payee does not sign the form. It records the name and/or designation on the check and the correct name and/or designation.

The form names each party in its blocks. It has no signature line for the payee.

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Questions about Form SF1147

Who issues SF 1147?

The form prints Standard Form 1147, Rev. 5/1995, Department of the Treasury, I TFRM 4-6000. GSA hosts a copy in its forms library.

Who fills out SF 1147?

An administrative office, with the signature and typed or printed name of its authorized certifying officer. The disbursing officer completes the block at the bottom when the replacement check is issued.

What does the certifying officer certify?

That the correct name and/or designation of the payee is as shown, that the amount stated is due the payee, and that issuance of a replacement check as indicated, for delivery in the usual manner, is authorized.

Which check details does the form ask for?

Check number, date, amount, symbol number and voucher number, the name and/or designation on the check, and the correct name and/or designation.

Can the previous edition be used?

The form says Previous edition is not usable.

Why does GSA's page show 1982?

GSA's page lists a current revision date of 03/1982, while the PDF itself prints Rev. 5/1995.