Pta Payment Authorization/request For Reimbursement Form
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1PAYMENT AUTHORIZATION/REQUEST FOR REIMBURSEMENT
ATTACH ALL RECEIPTS TO THIS EXPENSE STATEMENT
Name ________________________________________________________________________________________
PTA Position __________________________________________________________________________________
Address ______________________________________________________________________________________
City/Zip ______________________________________________________________________________________
Telephone (______)_______________________ Email ________________________________________________
Expenditure was for: __________________________________________
List Expenditures: ______________________
$ __________
______________________
$ __________
______________________
$ __________
______________________
$ __________
TOTAL EXPENSE
$ __________
Total Amount Claimed From Above
$ __________
Minus Advance Received
$ __________
Reimbursement Claimed
$ __________
Not claimed – donate to PTA
$ __________
Refund to PTA (Enclose Check)
$ __________
Signature __________________________________________________________ Date _____________________
F
PTA
:
OR
TREASURER USE
Membership-approved activity
Funds released by membership
Executive Board-approved expenditure
Check Number
Category
Amount Advanced
Expenses
Amount Owed or Due
President’s signature: _______________________________________________________ Date: ________________________
Date approved in minutes:______________________ Secretary’s signature: __________________________________________
03/2009
328
California State PTA Toolkit – 2013
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Parent category: Business