The form of the disbursement request must include, but shall not be limited to, the following items:

1. (1) Amount of deposit;
2. (2) Amount to be disbursed;
3. (3) Name and address of person or persons to receive disbursement and amount each is to receive;
4. (4) Signature of depositor; and
5. (5) Depositor’s signature to be notarized.

Codification Notes: This section as promulgated prior to codification into the Code of Arkansas Rules provided as follows: "3-27-19-617 FORM OF DISBURSEMENT REQUEST"