PTSA
Horace Mann Elementary
REQUEST FOR PAYMENT
Please note: The Treasurer(s) and President(s) will review all requests.
Requests not previously approved in the Budget will be reviewed by the Board of Directors.
Name:_______________________________________ Date:______________________
Pay to (if different from above):____________________________________________
Committee or Office:_______________________________________________________
Return check by:
□ Kid Mail – Child, Teacher _______________________________________________
□ PTSA File
□ Staff Box
□ US Mail (Provide Address)
____________________________________________________
____________________________________________________
Total Amount Requested: $_____________________________
Please attach receipts where indicated. Payment will not be issued without receipts.
Use of funds (please itemize and include tax):
_______________________________________________________________________ _______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Please do not write below this line
| ___________________________________________________________________________ |
Approved By_____________________________ Total Paid_________________________________
Check Number____________________________ Date Paid__________________________________