REQUEST FOR CHECKS

PAYMENT/DISBURSEMENT

LIBERTY P.A.T.S.

A non-profit public benefit corporation

REQUEST #:____________________

Date of Request: _________________________________    Amount: ________________

Booster Club: ____________________________________________________________

Event:  _________________________________________________________________

Payee:  _________________________________________________________________

Address: ________________________________________________________________

Phone: ___________________________       Fax #: ______________________________

Purpose: ________________________________________________________________

________________________________________________________________________

Budget Category: _________________________________________________________

Signature of Booster Club Treasurer: _________________________________________

Signature of Booster Club President: _________________________________________

(Original goes to P.A.T.S. Treasurer.  Sign in blue or red ink only.)

Contact Email or Phone: ___________________________________________________

Requests are due at noon on Friday and checks will be returned on Wednesday.  Attach all vendor invoices or receipts.  Checks will not be processed without invoices or receipts and authorized signatures.  For non-budgeted items please provide a copy of the meeting minutes authorizing expenditure.

Check #: ________________                         Date Issued:  ____________________

c/c  Treasure