American Lawyers Alliance

ALA Request for Reimbursement Form

Expense Reimbursement Form

Please ensure that your have approval from your committee chairman for this reimbursement before you submit this form.

Sharon Chappelear, Treasurer

740-927-5054

sschappelear@hotmail.com

2756 Patterson Road S.W., Pataskala, OH 43062

Date:

Amount:

Pay to the Order of:

Mail Check to:

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Expenses: (Please attach any substantiating receipts or bills)

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Purpose:

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Amount:

Purpose 1:

Amount 1:

Purpose 2:

Amount2:

Purpose3:

Amount3:

Purpose4:

Amount 4:

TOTAL:

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By checking above, I certify that I have approval for this reimbursement by my Committee Chairman. (Subject to verfication)

Signed and submitted by:

Committee or Office:

Approved by:

Committee Chairman:

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Please note : All In-KInd donations, money donations, and all donations of time should be reported below:

In-kind donation description

Click Here to Upload Receipts

An Affiliate of the American Bar Association

in Austin, Texas