Reimbursement / Check Request Form

Instructions to submit a reimbursement request online:

Complete this form with all receipts attached.
Checks will not be issued without receipts.
Payments for taxes will not be reimbursed.
Submit form & receipts to McKenzie PTA Treasurer’s Mailbox (not via email) or electronically using this form.
Submit receipts within 30 days of purchase (all June 2019 receipts are due by 6/05/2019).
Arrangements will be made with Chairs of 4th Grade Farewell and Last Day Event.
Indicate check delivery method via School Mailbox or Attached Stamped Envelope below.
(For Enrichment) A copy of completed from will be emailed to Enrichment VP.

IMPORTANT! The PTA does not reimburse sales tax. When making purchases for the PTA, please present the Tax Exempt Letter to the store/vendor at the point of sale. Copies of this letter can be found here or in the PTA mailbox at school. (Note: Office Depot has its own tax exempt number. Contact Treasurer for details).

Questions? Contact
Julieta LaMalfa, PTA Treasurer
treasurer@mckenziepta.com

Reimbursement / Check Request Form

Expenses*
Date PTA Committee Grade Level(s) Name of Items/Events Amount (less tax) Full Payment (or deposit)
Total*
Make check payable to:*
Deliver the check to:
- PTA Mailbox (please specify below)
- Mail (include address below)
PTA Mailbox
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Your Name*
First Last
Your Email*
Your Position*
- PTA Committee Chair
- Committee Member
- Parent
- Other
Committee Chair Email*
Please include the email address of your Committee Chair.
Receipt(s)*
Take a picture of the receipt and upload it here.
Drop files here or
Notes/Comments

Date	PTA Committee	Grade Level(s)	Name of Items/Events	Amount (less tax)	Full Payment (or deposit)