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Reimbursement Request
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Northside Elementary PTO
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YOUR NAME:PHONE:
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PROJECT/CATEGORY:
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DATE SUBMITTED:DATE MAILED:
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REASON FOR REIMBURSEMENT:
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INCLUDED IN
ANNUAL BUDGET		orAPPROVED AT MEETING
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DATE:
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CHECK PAYABLE TO:AMOUNT:
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 $ 0.00
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FULL ADDRESS (your check will be mailed to you):
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Receipt(s) totaling the amount of reimbursement must be included.
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APPROVED BY (PTO OFFICER):DATE:
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APPROVED BY (PTO OFFICER):DATE:
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FOR TREASURER'S USE ONLY: Category _________ Check # __________ Date _____________ Logged _____________
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