ABCDEFGHIJKL
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Reimbursement Request
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Check Requested By:
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Check Payable To:
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(First Name or Company)(Last Name)Check NumberTreasurer's Use Only
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EFT
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(Address)Date
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Check Amount
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(City)(State)(Zip)
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Check For:
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DATEDESCRIPTIONAir &
Trans.
LodgingFuel / MileageProf/ ConferenceMeals
& Tips
EntertainmentOtherTOTAL
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0.00
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0.00
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0.00
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0.00
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0.00
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0.00
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0.00
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0.000.000.000.000.000.00
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Note: Mileage reinbursement for personal car will be based on the IRS RateSUBTOTAL$0.00
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* Don't forget to attach receipts *ADVANCES
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Itemized Expenses or Description for "Other"TOTAL $0.00
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DATEDESCRIPTIONAmountTreasurer's Use Only
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Date Recieved:_______________Board TravelNational Annual Assembly Conf
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Date Processed:______________Chapter MeetingTNCC Teaching
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Date Distributed:_____________State meetingENCP Teaching
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Route: Mail / Hand / EFTDelegateOther Teaching
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State ConferencePublic Education
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National Leadership ConfOther: _______________
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Approved By: ___________________________Date:___________________________