A	B	J	K	L	N
1	EVERETT PUBLIC SCHOOLS DIST. NO 2									REIMBURSEMENT VOUCHER
2
3	THIS FORM IS TO BE USED TO REQUEST REIMBURSEMENT BY INDIVIDUALS WHO MAKE PURCHASES ON
4	BEHALF OF EVERETT PUBLIC SCHOOLS.
5
6	ORIGINAL RECEIPTS MUST BE ATTACHED.
7
8	PAYEE:			AMOUNT:	$
9		(PLEASE PRINT)
10
11	PAYEE SIGNATURE:
12	I hereby certify under penalty of perjury that this is a true and correct claim for necessary expenses incurred by me
13	and that no payment has been received by me on account thereof.
14
15	LOCATION/ADDRESS:
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17	PAYMENT FOR THE FOLLOWING:
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26
27	ACCOUNT CODE:
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29	CHECK NO.:		CHECK DATE:
30
31	AUTHORIZED BY:
32						Revised Aug 2003
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34	EVERETT PUBLIC SCHOOLS DIST. NO 2									REIMBURSEMENT VOUCHER
35
36	THIS FORM IS TO BE USED TO REQUEST REIMBURSEMENT BY INDIVIDUALS WHO MAKE PURCHASES ON
37	BEHALF OF EVERETT PUBLIC SCHOOLS.
38
39	ORIGINAL RECEIPTS MUST BE ATTACHED.
40
41	PAYEE:			AMOUNT:	$
42		(PLEASE PRINT)
43
44	PAYEE SIGNATURE:
45	I hereby certify under penalty of perjury that this is a true and correct claim for necessary expenses incurred by me
46	and that no payment has been received by me on account thereof.
47
48	LOCATION/ADDRESS:
49
50	PAYMENT FOR THE FOLLOWING:
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59
60	ACCOUNT CODE:
61
62	CHECK NO.:		CHECK DATE:
63
64	AUTHORIZED BY: