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[null,null,"Please indicate where reimbursement should be sent"]
[null,null,null,"Mail to my home"]
[null,null,null,"Leave in the PTA Drawer at School"]
[null,null,null,"Other: "]
[]
[null,null,"PTA REQUISITION FOR PAYMENT FORM"]
[{"$nulls":5},"Date"]
["Requested by:",null,null,null,"Email:"]
["Address"]
[{"$nulls":4},"City",null,"Zip"]
["Phone",null,null,"Amount"]
[{"$nulls":4},"Requested:"]
[null,"Request Reimbursement OR",null,null,"Request Payment of Invoice to:"]
[]
[]
[]
[]
["ITEMIZE EXPENSES BELOW (submit additional copies if needed)"]
[]
["Budget Line Item",null,"Purpose of Expense",null,"Item Amount","Tax","Total Amount"]
[]
[]
[]
["*Receipts and/or invoices are required before payment can be made. Please attach."]
[]
["Authorized by:",null,null,null,"Date"]
[null,"President's Signature"]
[]
[]
["FOR TREASURER'S USE ONLY"]
["Check Number",null,null,null,"Date Paid:"]
["Other Information"]
["Treasurer's Signature:",null,null,null,"Date:"]