Congregation Havurah Shalom Check Request

 

Amount                         Date of Request:                                   Date Required:                    

 

Requestor Name:                                                                                                                          

 

Reason for Request:                                                                                                                    

 

Budget to be Charged:                                                                                                                

 

One Time or Recurring Charge (explain):                                                                             

 

Explanation if Unbudgeted Item:                                                                                              

 

Identify event, activity, committee, etc. covering this expense:

 

                                                                                                                                              

 

Receipts must accompany all requests for reimbursements.

Explanation if receipts are not available:                                                                                

 

 

APPROVAL:  (Responsible Board Member or Committee Chair other than the Requestor)

 

                                                                                                                    

Print Name                                                                     

 

                                                                                                                    

Signature                                                                                      Date

 

Sales tax will not be reimbursed since we are exempt from sales tax. Completed sales tax exemption forms are available from Allan Milder, CHS Treasurer.

 

Forward completed check requests to:

 

Allan Milder

221 Monument Hill Trail

Georgetown, TX 78633