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PTA
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everychild, onevoice
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Payment Authorization Form
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Benjamin Fox Elementary PTA
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Please complete this form in it's entirety. Incomplete forms will delay payment processing. If completing for more than one event provide & highlight the totals for each event and label the receipts/invoices. Reimbursements Need to be submitted within a 60 Day Timeframe
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Room Parent Budget: $450/class
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Teacher Field Trip Admissions: $250/class
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Classroom Teacher Budget: $800/class
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Specialist Teacher Budget: $250/class
Date
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Name of Person Requesting CheckPhone()
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PTA PositionRoom ParentCity/Zip
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ClassGradeOther
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Event or Assignment
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Date of EventAmount Requested$100.00
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Date Approved in Minutes
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Invoice attached
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Receipt attached
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Write Check To:
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Name of Person/Company
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Address
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Belmont
94002()
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CityZip
Phone
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Approved by:
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President's Signature
Secretary's or Financial Secretary's Signature
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For PTA Treasurer use:
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Membership-approved activity
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Executive Board-approved expenditure
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Funds released by membership
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Budget Category
Budgeted Amount
Check Number
Amount
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