4-H Club Purchase Form

Linn County 4-H Purchase/Payment Form

To be submitted by Youth Officer and/or Club Leaders
Staff needed to purchase itemsReimbursement (to volunteer or youth)Invoice to business needs to be paid.Monetary Donation to another organization - Minutes will be required
Club*
Who is Extension paying?*
Address to send payment to

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What club budget line is this purchase from? If not in budget, minutes required please list "see minutes" below*
If the purchase was not included in your budget or is a monetary donation to another organization, attach club minutes below.
Item Description/Link to purchase and Cost
Total Cost*
Receipts & other documentation including minutes*

Cancelof
Purpose

All 4-H funds are classified as public funds. This means that the state auditor and the public can question why things were purchased. The following questions help make us audit proof.
Event that the purchased items are for *
Date of event*
Increase members' sense of belonging (Team Building, Club Identity)Practice Mastery (Project and SPARK exploration)Encourage Independence (career explorations, life skill development, leadership)Demonstrating Generosity (Community Service)Other
Signatures
Youth Officer Name

First NameLast Name
Youth Officer Signature
Club Leader Name*

First NameLast Name
Club Leader Signature*
Email for confirmation of submission to be sent to:*
example@example.com
Club Leader Name

First NameLast Name
Club Leader Signature
Should be Empty:

Linn County 4-H Purchase/Payment Form

Purpose

Signatures