Canyon Rim PTA Reimbursement Request

Please list all items purchased, amount paid, and the event or budget item.

Total Reimbursement Requested
Total Number of Receipts Attached
Make Check Payable To
Check Distribution

Teacher’s MailboxGrade:
Grade
Name
Check Distribution

Mail to Payee
Address
Other

(email treasurer@canyonrimpta.org or text Jen at 480-580-2570 to coordinate)
Received By:
Date Received:

MonthDayYear
Date
Treasurer Use Only
Check Date

MonthDayYear
Date
Check
Amount
Signature

Clear
Should be Empty: