NORTHEAST ZONE of WASHINGTON STATE HORSEMEN Reimbursement Request Form Payable to: _________________________________________ Date: ______________ (Include First &Last Name) Mailing Address: ________________________________________________________ City: __________________________ State: _______________ Zip: _______________ Item Purchased: __________________________________________________________ Amount to be reimbursed (attach receipt): _____________________________________ NEZ Division: (circle the appropriate area responsible for this expense) General Fund Games Horse Show Trails & Pleasure Youth Merit Authorized/approved by: __________________________________________________ (Division Chairman Signature) If expense is to come out of the ‘General Fund’, date of meeting that payment was approved: __________________________________________ Submit completed request to: Cheryl Moriarty, NEZ Treasurer 26728 W. Tucker Prairie Rd Cheney, WA 99004 Or scan/e-mail to: tpappys@gmail.com Reimbursements requests submitted without the Division Chair’s approval/signature may be delayed/returned for completion. Treasurer use: Date paid: ______________________________ Check #: _______________________________