budget

Amount Requested
$

Date:

Person requesting payment: (Name & Phone Number)

Pay to the order of:

Payment is charged to what event"

For what purpose was expenditure made.

Mail check to:

Address:

Other instructions:

PLEASE ATTACH ORIGINAL CASH REGISTER RECEIPTS OR SALES SLIP
County Council Must Approve any request older than 90 days.

For Treasurer's use:

Payment date

Check No

Budget charged

Updated 03/13/2008