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Stonehill Seventh-day Adventist Church
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Reinbursement Claim form
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Date:
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Name of person to be paid:
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Mailing Address:
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Phone:
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DepartmentTreasury CodeDescription /ReasonAmount
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Total$0.00
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Authorized By:Name:
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Signature:
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Please make sure that the following is included:
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1) Original receipts
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2) Mission Team Chair Signature if needed
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To promote timely and accurate payment of your claim, please complete before printing.
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Last form revision 021711
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