Itemized Receipt Form

(To be used when giving funds to Treasurer)

 

Event                                                                                                      Date                                            

                                                                                                              

Chairman                                                                                                Phone No.                                                                                                                                                             

Person completing form                                                                          Phone No.                                                                      

 (Please make sure that there are always 2 people counting money to protect the reliability of the count)     

                                                                                                                                                                                         

 

Total of checks (attach a tape/written account)                 $                                                                                      

 

Bills	#	Amount
$100
$50
$20
$10
$5
$2
$1
Total

                                                                                                                         

 Total Bills                 $                                          

 

Coins	#	Amount
Dollar
50 Cent
Quarters
Dimes
Nickels
Pennies
Total

                                                                                                                                                                

                                                             Total Coins                $                                          

                                                                                                                                          

                                                                               Total Cash           $                                           

                                                                                                                   

                                                                                     Total Deposit      $                                           

 

Counter’s Signature                                                                                                                                          

Counter’s Signature                                                                              Date                                          

Received by Treasurer                                                                          Date                                          

(When turning in a deposit, please allow time for another count of the total deposit

so a receipt can be given to the person turning in the deposit)