Ravensworth PTA Payment Request

’08-09 Treasurer: Xinli Mataya, 5258 Signal Hill Drive, Burke, VA 22015

(703) 425-3246 or E-Mail: pmataya@yahoo.com

Requestor’s Name: Date:

Phone # or E-Mail: ________________________________________________

Purpose of Expense: ______

Type of Payment

□ Reimbursement

□ Direct Payment:

Attach original invoices or receipts. All reimbursements must have receipts. Payment requests need to be turned in within 30 days of expenditure.

Check Payable To:

Mail Check To:

Name:

Street:

City, State, Zip:

Date:	Description	Amount
	Total:

For use by Treasurer

Check Number: _____Date: Expense Category

All PTA Records Audited on Annual Basis

Ravensworth PTA Deposit

’08-09 Treasurer: Xinli Mataya, 5258 Signal Hill Drive, Burke, VA 22015

(703) 425-3246 or E-Mail: pmataya@yahoo.com

Committee Name: Date:

Description:	# Members / Registrations	Amount
Membership
Sally Foster
Book Fair
Spirit Night
Bingo Night
Box Tops
Ice Cream Social
Yearbook
Other
	Total:

Depositor: Treasurer: Date:

All PTA Records Audited on Annual Basis