EXPENSE REIMBURSEMENT FORM
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DATE: _________________ COMMITTEE: ________________________
SIGNATURE OF PERSON (CHAIRPERSON) REQUESTING CHECK:
___________________________________________________________
WHAT CHECK IS FOR: ________________________________________
BUDGETED OR APPROVED BY BOARD: YES _____ NO _____
ATTACH RECEIPT OR EXPLANATION IF NO RECEIPT IS AVAILABLE.
NAME OF PAYEE: ___________________________________________
AMOUNT: __________