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FUNDS/REIMBURSEMENT REQUEST FORM~CC REQUESTER FILLS IN THIS SECTION

 x 

Funds

[receipts must be submitted within 10 days of the event and any unused portion returned within 15 days of disbursement. ]

Reimbursement

[Receipts must be attached. Reimbursement request must be submitted within 30 days of the event +

Reimbursement request for the year must be filed before the last date of filing for fund/reimbursement of said year.]

Date of request 1/12/2014 Amount $  $165.43     CODE MAND2 MAND3 OFF. USE

        

Budget line description Spiritual Development and Worship Christian Fellowship

Charge to budget line [Fill in code]

MAND3

Person requesting DAN YAO Check(s) payable to  Dan Yao    

$

165.43

$ $ $ $ $ $ $ $

Receipts OFF.USE 

        

CODE MAND6

Budget line description Life Camp and Outreach

Purpose/For:

#

Food and supplies for Sunday and Fellowships

Dan Yao Signature for requester __________________________ C. Chyn Approved by Carleton (Chih) Chyn __________________________________ Note: Approval must be obtained on all purchases. Failure to obtain approval may result in purchaser having to incur the expenses. If item has already been purchased, please attach receipt(s) to this form. Otherwise, provide receipt(s) as soon as possible after purchase. Signature of approval required before treasurer will issue reimbursement. All purchases above $500 must be approve prior of purchases.

Approved by _________________Date _____________

Over $5,000 Assistant Treasurer

X __________________

FOR TREASURER’S USE ONLY Date issued _________________

Check ________ ________________________________

Notes: ___________________________________________________________________________________ __________________________________________________________________________________________ Queens Christian Alliance Church, 135-20 35th Avenue, Flushing, NY 11354. Tel. 718-353-2745

V2011


Date of Receipt 1/4/2014

Amount Purpose $ 88.79 Food Supplies for Sunday 1/5/2014

1/4/2014

$

13.86 General Food and supplies for storage

1/11/2014

$

62.78 Food Supplies for Sunday 1/12/2014

Total

$ 165.43


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Cashier # ,l05

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$25,4'lF $2,49F

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Reimbursement Form