Pomeroy Elementary PTO
Payment-Withdrawal Form
(This form is only to be initiated by a current board member.)
This form is for processing bills or invoices with a Referenced Expenditure Authorization. If there is no Referenced Expenditure
Authorization, a majority of the Executive Board Members must vote to approve the transaction beforehand.
For a payment of withdrawal without a Referenced Expenditure Authorization that exceeds $500, use the Quorum Form.
Initiator:_________________________________________ Date: ________________________
The initiator will be responsible for ensuring the tracking of this form through the process.
Expenditure Authorization Reference: ______________________________________________
(Yearly budget or minutes of meeting)
To whom did the payment or withdrawal go: _________________________________________
Total payment or withdrawal: _____________________________________________________
Date of payment or withdrawal: ___________________________________________________
Signature for personal reimbursement (if needed): _____________________________________
Expenditure Identification: Indicate the appropriate category and sub-category
PTO Operational Expenditures
 Fundraising Expenses
 Office supplies/ Equipment
 Postage
Other Expenditures
 Supporting Pomeroy
 Supporting Pomeroy Education
 Supporting Pomeroy Community
PTO Board Members Vote
A quorum is a minimum of five members, including three current executive board members.
President:
 Yes
 No
Vice President:
 Yes
 No
Secretary:
 Yes
 No
Treasurer/Co-treasurer:
 Yes
 No
Volunteer Coordinator:
 Yes
 No
Teacher Representative:
 Yes
 No
______________________________________________________________________________
Attach all supporting documentation, receipts and/or contracts. Forward to treasurer.
Date received by treasurer: _______________________________________________________
Date logged: ___________________________________________________________________
Updated 9/2011