Jack and Jill of America, Inc.

VOUCHERThis form is to be used to request the issuance of a check for payment.PAYEE NAME TELEPHONE

STREET CITY / STATE ZIP CODE

DATE OF VOUCHER

DESCRIPTION OF DISBURSEMENTS: LINE ITEM AMOUNT

$

$

$

$

$

$

$

$

$

TOTAL AMOUNT $__________________

REQUESTED BY DATE

TITLE/POSITION/COMMITTEE DATE

APPROVED: NATIONAL PRESIDENT DATE

Checks will be issued only when this form isprepared on a typewriter or in ink.

Support documents such as original receipts mustaccompany this form.

A separate voucher must be submitted for eachcheck requested.

All copies must be submitted to the NationalTreasurer.

APPROVED: NATIONAL TREASURER DATE

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TO BE COMPLETED BY NATIONAL TREASURER ONLY

VOUCHERNUMBER

CHECKNUMBER

AMOUNT ENTRY DATE and PERSON

VOUCHER: 9/2000