Cornell Elementary School Pta Reimbursement Request Form

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Cornell Elementary School PTA
Reimbursement Request
Date: _________________________ Amount Requested: _________________
Your name: ______________________________________________________
Check payable to: _________________________________________________
Check one:
I will pick up check in office.
Mail check to me at the below address.
___________________________________________________________
___________________________________________________________
Mail check to vendor at the below address.
___________________________________________________________
___________________________________________________________
___________________________________________________________
Please list all receipts/expenditures included in this request.
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Approved
Denied because ________________________________________________
Date Paid _____________________ Check No.__________________________

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