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Harlingen CISD-Vernon Middle School
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Cash Receipt Form
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Attachment #3 - Student Activity Manual
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Revised 2/28/17 sdl
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Date:Name of Club:
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Person Depositing:
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Total Amt of Deposit: $ -
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Office Receipt #
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BeginningEnding
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Club Receipt #: To
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Total Currency: $ -
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Total Coins: $ -
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Total Checks: $ -
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Detail Check Listing:
Activity/Reason for Deposit:
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Name on CkCk #Amount
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CurrencyCoins
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# of Bills
# of Coins
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 $ 1.00 $ - 1¢ $ -
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 $ 2.00 $ - 1¢ Roll $ -
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 $ 5.00 $ - 5¢ $ -
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 $ 10.00 $ - 5¢ Roll $ -
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 $ 20.00 $ - 10¢ $ -
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 $ 50.00 $ -
10¢ Roll
 $ -
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 $ 100.00 $ - 25¢ $ -
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25¢ Roll
 $ -
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Total $ - 50¢ $ -
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 $ 1.00 $ -
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Total $ -
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Total Checks: $ -
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Club Sponsor:
Date:________
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Person Depositing:
Date:________
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