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Forms -- Section Expense Reimbursement Request

_____________________________________
(Name of section, subsection or committee) :

REQUESTING PARTY

    Name: _______________________________________________________

    Address: _____________________________________________________

REIMBURSABLE EXPENSES

:

Date Incurred Item Amount
___________ ______________________________ $ ______________
___________ ______________________________ $ ______________
___________ ______________________________ $ ______________
Total Expense:    $ ______________
:
MEAL EXPENSES $ ____________________
PRINTING EXPENSE $ ____________________
POSTAGE / LABEL EXPENSE $ ____________________
OTHER EXPENSES $ ____________________

LINE ITEMS TO BE CHARGED

PURPOSE: _______________________________________________________________

.

Attach All Receipts. Receipts Required For Total Expenses of $75 or more

____________________________________
Signature of Requesting Party		 _____________________________
Date

APPROVAL BY SECTION/COMMITTEE CHAIRPERSON AND SECTION LIAISON:

____________________________________
Signature of Chairperson		 _____________________________
Date

____________________________________
Signature of Section/Subsection/Committee Liaison		 _____________________________
Date