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MPES PTO Reimbursement Request Form In order to receive reimbursement this form MUST be submitted within 1 month after the event/occurrence for which expenses were made. PHONE YOUR NAME - PROJECT/CATEGORY DATE SUBMITTED REASON FOR REIMBURSEMENT INCLUDED IN ANNUAL BUDGET or APPROVED AT MEETING DATE // CHECK PAYABLE TO AMOUNT FULL ADDRESS Your check will be mailed to you. Receipt s totaling the amount of reimbursement must be attached* APPROVED BY PTO OFFICER DATE -------------------------------------------------------------------------------------------------------------------------------------------------------For Treasurer s Use Only Category Check Date. PHONE YOUR NAME - PROJECT/CATEGORY DATE SUBMITTED REASON FOR REIMBURSEMENT INCLUDED IN ANNUAL BUDGET or APPROVED AT MEETING DATE // CHECK PAYABLE TO AMOUNT FULL ADDRESS Your check will be mailed to you. Receipt s totaling the amount of reimbursement must be attached* APPROVED BY PTO OFFICER DATE -------------------------------------------------------------------------------------------------------------------------------------------------------For Treasurer s Use Only Category Check Date.

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