OPLL EXPENSE REIMBURSEMENT REQUEST FORM
(Please attach all supporting invoices and reciepts)
Requested by (print):					SIGNED:______________________
Date submitted:
Make check payable to (payee):
Check amount:
Special instructions:				Mail to:
(delivery instr., payment address,
expedite, etc.)
Date	Description of Expenditure							Amount
					Total expenditure			0.00
Review/Approvals:							Payment:
Treasurer:							Date	Check #
Other: