New Expense Form for 2021
St. Clare of Assisi Knights of Columbus Council 7119
EXPLANATION OF EXPENSES
Page ____ of ____ Pages
Submitted by: ________________________________________ Print Name
__ Request for Member Expense Reimbursement (Description)
Or
__ Request for Disbursement of Funds (Payable to)
(Please Print)
Date Description/Payable to Amount
_______ ____________________________________ ________
_______ ____________________________________ ________
_______ ____________________________________ ________
_______ ____________________________________ ________
I certify that the expenditures set forth (Check one):
___Were incurred for charitable events on behalf of Council 7119 (Essay Contest, Free throw contest, High School Scholarships, ect.)
___Are for goods or services I rendered on behalf of Council 7119 (attach receipts)
Requestors signature: ______________________ Date: _________
Grand Knight Approval: _____________________ Date: _________
Download the .pdf or copy the form and then paste it to a blank word document.

