reimbursement

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					  PMYFCL REIMBURSEMENT REQUEST FORM
                               Attach Original Receipts

First Name:____________________              Last Name:____________________________

Street Address:_________________________________________________________

City:________________________              State:___________          Zip Code:____________

Social Security Number (if reimbursed over $600 annually):_________________________


                               ITEMIZED EXPENSES
DATE            DESCRIPTION                  BUDGET CATEGORY                               COST
________        ____________________________ ___________________                          $______

________        ____________________________              ___________________             $______

________        ____________________________              ___________________             $______

________        ____________________________              ___________________             $______

________        ____________________________              ___________________             $______

                                                Total Amount To Be Reimbursed $_________

ORIGINAL RECEIPTS MUST BE ATTACHED TO THIS REQUEST FORM in order to
receive payment for the above request. Only Pal-Mac Youth Football & Cheerleading League Board
Members & Coaching Staff will be authorized to complete and file a reimbursement request and/or
receive payment for reimbursement from PMYFCL. All other volunteers/members must submit an
itemized invoice for payment to PMYFCL. In order to be reimbursed you must be a PMYFCL member
who has authorization for said purchase. If you are not an authorized purchaser and/or you do not fill
out request form completely with original receipts attached your request for reimbursement will be
denied and you will be responsible for payment.

_______________________________________________                         ___________________
Signature for Reimbursement                                             Date


_______________________________________________                         ___________________
Approval Signature                                                      Date

				
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