District IV Expense Report

Date: _________________________

___ District IV AFG        ___ District IV LDC        ___ 2003 Area Convention

Your Name: ___________________________ Phone: ___________________________

Your Mailing Address: ____________________________________________________

Vendor: ______________________________ Phone: ___________________________

Mailing Address: _________________________________________________________

Items Purchased:  Attach Receipts

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Reason for Purchase:

________________________________________________________________________

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Signature: _______________________________

Send to: District IV AFG P. O. Box 550156, Birmingham, AL  35255

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FOR DISTRICT USE ONLY

____ Approved    ____ Denied – Reason ___________________________________

Paid By: __________________  Paid Check # ___________  Date: ________________

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