Laurel Mountain Pta Itemized Receipt Form
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1Itemized Receipt Form
Laurel Mountain PTA
(To be used when giving funds to Treasurer)
Revised 8/11
Date:____ /____/____
______________________________
Account to be Credited:
(Event or program name)
Committee Chairman:
Phone:
______
Person completing form:
Phone:
_______
(If different from Committee Chair)
Coins
Number
Amount
Currency
Number
Amount
Penny
$
One
$
Nickel
$
Two
$
Dime
$
Five
$
Quarter
$
Ten
$
Half Dollar
$
Twenty
$
Dollar
$
Fifty
$
Total Coins
$
Hundred
$
TOTAL Currency
$
Check No.
Check Amt
From
Check No.
Check Amt
From
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
If more space needed, please list additional check information on back of form
Total Checks
$
_
Total No. Checks:_____
Total Coins and Currency
$
Total Deposit
$
Counter’s Signature
Counter’s Signature
Date
Received by Treasurer
Date
__________________________
Deposit Date:
To be completed by Treasurer:
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