Back Date
______________________
Amount __________________
Make Check payable to _______________________________________________
Address to be mailed to: _______________________________________________
Account to charge ___________ Department/Commission
___________________
Business purpose of expenditure ________________________________________
Must be
initialed by one of the following:
Pastor, Parish
Manager, Principal: _______________________________________________
Signature of person requesting reimbursement _____________________________
(Receipts must be attached)
NOTE:
If the receipts accompanying and substantiating this reimbursement
request contain ANY ITEMS or cost not connected to the expense, they are
invalid and cannot be accepted for reimbursement.