Funds Verification Form - Georgia Pta
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Date
Activity
Chairperson
Budget category
Petty cash must be accounted for separately on its own form.
Section 1: Use this section is you are collecting money only by cash/checks. After funds are deposited in the bank by the
treasurer, a copy of the deposit slip must be attached to this form.
X
.01
=
Coins
X
.05
=
X
.10
=
X
.25
=
X
.50
=
X
1.00
=
Total 1 $
Currency
X
$1.00
=
X
$5.00
=
X
$10.00
=
X
$20.00
=
X
$50.00
=
X
$100.00
=
Total 2 $
How many?
(Itemized list on back page)
Checks
Total 3 $
Grand Total (Total 1 + Total 2 + Total 3)
$
Section 2: Use this section is you are collecting money by credit card. Transaction report must be attached.
Credit Card Gross (all money collected)
1 ______________
Credit Card Processing Fees
2 ______________
Credit Card Net (should be what is deposited in the bank)
Grand Total (1 minus 2) ______________
For Membership dues submission, please complete this box.
#_____ members @ $_________ (dues amount) = $_________+ donations $_________ + other $__________ - fees $ _______= $____________
Please note: This total should match one of the Grand Total boxes above.
Verification: (signature of the two counters Ð cannot be related and cannot be the treasurer)
By signing this form, you are certifying that these funds were received and properly accounted for.
Signature
Signature
For TreasurerÕs Use Only
Amount received: $____
Date received:
Date deposited:
(must be same day or within 24 hours)
TreasurerÕs Signature
Date
Note: After the treasurer verifies and deposits funds, he or she should provide a copy of the deposit slip to the person who submitted the funds.
134
everychild. onevoice.
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