12th District PTA Payment Authorization/Request for Reimbursement (Attach all receipts to this statement. Keep copies for your records) Requested By: PTA Position: Phone: E-mail: Date of Amount of BUDGET CATEGORY/EVENT Expenditure Expenditure $ $ $ $ TOTAL AMOUNT REQUESTED $ ❒ ❒ Invoice and/or receipt MUST be attached: Invoice attached Receipt attached Make Check Payable to: Address: City: Zip: Please send requests to: Maria Steck, 12th District Treasurer 3752 Corte de Los Reyes Thousand Oaks, CA 91360 Questions? Email: msteck3@gmail.com Phone: (805) 300.8746 Signature of Person Making Request: Date: For 12th District PTA Treasurer Use Only ❒ ❒ Membership-approved activity Funds released by membership ❒ Executive Board-approved expenditure Budget Category Exp Amount Amount Advanced Amount Due Check # Date Paid President’s Signature: Date: Date Approved in Minutes: Secretary’s Signature:
12th District PTA Payment Authorization/Request for Reimbursement (Attach all receipts to this statement. Keep copies for your records) Requested By: PTA Position: Phone: E-mail: BUDGET CATEGORY/EVENT Date of Expenditure Amount of Expenditure $ $ $ $ TOTAL AMOUNT REQUESTED $ Invoice and/or receipt MUST be attached: ❒ Invoice attached ❒ Receipt attached Make Check Payable to: Address: City: Zip: Please send requests to: Maria Steck, 12th District Treasurer 3752 Corte de Los Reyes Thousand Oaks, CA 91360 Questions? Email: msteck3@gmail.com Phone: (805) 300.8746 Signature of Person Making Request: Date: For 12th District PTA Treasurer Use Only ❒ Membership-approved activity ❒ Funds released by membership ❒ Executive Board-approved expenditure Budget Category Exp Amount Amount Advanced Amount Due Check # Date Paid President’s Signature: Date: Date Approved in Minutes: Secretary’s Signature:
12th_district_payment_auth-req_for_reimbursement__form.docx