F-SA-6 Multiple Receipt Form.xlsx

	A	B	C	D	E	F	G	H	I	J	K	L
1	JEFFERSON CO PUBLIC SCHOOLS											F-SA-6
2	MULTIPLE RECEIPT FORM								MR#
3
4									Note: Students 6th grade and above must sign form as they turn in money. K-5 Teacher/Sponsor may print names.
5		Name of School
6		ACTIVITY ACCOUNT:						Grade: (Circle One/Multiple)
7		PURPOSE:							K-5	6	7	8
8		TEACHER/SPONSOR NAME:							9	10	11	12
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10		Student Signatures or Printed Name	mm / dd		mm / dd		mm / dd		mm / dd		mm / dd
11			/		/		/		/		/
12			Cash/Ck Amount	Ck No	Cash/Ck Amount	Ck No	Cash/Ck Amount	Ck No	Cash/Ck Amount	Ck No	Cash/Ck Amount	Ck No
13	1
14	2
15	3
16	4
17	5
18	6
19	7
20	8
21	9
22	10
23	11
24	12
25	13
26	14
27	15
28	16
29	17
30	18
31	19
32	20
33	21
34	22
35	23
36	24
37	25
38	26
39	27
40	28
41	29
42	30
43		Sponsor Collected Cash
44		Sponsor Collected Checks
45		Sponsor Collected Total
46		SPONSOR SIGNATURE
47		Total Money Per Bookkeeper
48		BOOKKEEPER SIGNATURE
49		Receipt Number
50		Date*
51		*Date receipted into EPES (for No Bank Schools, use deposit date)
52		The form and collected money must be given to the Bookkeeper DAILY. The Bookkeeper is REQUIRED to give each individual turning in money a receipt. Staff person should ensure they receive receipt.
53
54		Printed name acceptable for any student unable to sign.
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