DISBURSEMENT FORM
Only expenses for Association activities approved in the Annual Budget are eligible for reimbursement and such requests must follow the procedures set forth on this form. All expenses must be approved by the appropriate committee or project chair, who must also sign this form along with the member seeking reimbursement. 
Expenses for any non-budgeted activity MUST receive prior Executive Board approval before such is incurred or no reimbursement for it will be made. All requests for reimbursement MUST: 
1) Be submitted to the Treasurer on this form, and 
2) Include all original receipts stapled to the upper right hand corner, and 
3) Be submitted within 30 days of incurring the expense, and 
4) No taxes will be reimbursed for any submitted expenses (request Sales Tax 
Exemption form from Treasurer before incurring expenses) 
Please allow up to 2 weeks for check to be issued and mailed. 

Person Requesting Check: 	Date Submitted: 		Treasurer Use Only 	
			Budget Category: 	
Committee/Activity Name (Only one per disbursement form) 			
		Date Received: 	
Itemization of Expenses 	Amount 		
	$ 	Date Paid: 	
	$ 		
	$ 	Check Number: 	
	$ 		
	$ 	Budget Year: 	
Total 	$ 		
Requestor Signature: * 		Notes: 	
Committee Chair Signature: 			
Payee Name: Payee Phone #: 			
Payee Mailing Address 			

*Requester’s signature above certifies expenses submitted with this form were incurred for the stated TCMGA activity and were used exclusively for that purpose. 
Revised 2/9/08