Request for Reimbursement Forms

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2			PLEASANTVILLE COMMUNITY SCHOOL DISTRICT
3			REQUEST FOR PAYMENT - GENERAL FUND
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8	DATE:				AMOUNT REQUESTED
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11	PAID TO:
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19	PURPOSE:
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24				SIGNATURE:
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26		AUTHORIZED BY:		PRINCIPAL:
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28				SUPERINTENDENT:
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32	**Please attach copy of entry form for contest entry fees or receipts or invoices for reimbursement.
33	(These must accompany this sheet in order for check to be processed.)
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