AFFILIATE DISTRICT EXPENSE VOUCHER

DATE:
AMOUNT

REQUESTED: $
PAYABLE TO:
ADDRESS:
PURPOSE:

Signed: _____________________________________________

FOR DISTRICT TREASURER’S USE ONLY:

DATE PAID:	CHECK NUMBER:
AMOUNT PAID: $

Signed: _____________________________________________

LC-18

(Rev. 5-2009)

AFFILIATE DISTRICT EXPENSE VOUCHER

DATE:
AMOUNT

REQUESTED: $
PAYABLE TO:
ADDRESS:
PURPOSE:

Signed: _____________________________________________

FOR DISTRICT TREASURER’S USE ONLY:

DATE PAID:	CHECK NUMBER:
AMOUNT PAID: $

Signed: _____________________________________________

LC-18

(Rev. 5-2009)

Sharon Eberhardt

2009-05-27