ABCDEFGHIJKLMNOPQRSTUVWXYZ
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YOUR ISD NAME$0.00
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NAME OF SCHOOL DISTRICTFLOW THROUGH TO DISTRICT ALLOWANCE
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TEA HOMELESS CHILDREN and YOUTH (TEHCY)
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EXPENDITURE REPORT
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Revenue/Expense ItemsREIMBURSEMENT REQUESTBALANCE REMAINING
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 $ -
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5xxx Revenue Received
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61xx Payroll Costs
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62xx Contracted Services
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63xx Supplies and Materials
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64xx Other Operating Costs
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2xxx Accruals (enter as negative)
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NET REIMBURSEMENT DUE $ -
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CASH BALANCE PER GL (enter as negative)
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VARIANCE (should be 0) $ -
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I hereby certify that this report is true and correct and that funds have been expended according to the approved grant/contract.
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 Signature: Date:
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(prepared by)
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Email to :
bschlueter@esc14.net ; thaywood@esc14.net
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Note: Please attach your Detail General Ledger of the fund you are requesting reimbursement.
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For ESC Office Use Only: Payment Authorization:
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Date:
Account Number:
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Director Signature:
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