FUNDS TRANSFER/DEPOSIT FORM

Event/Category: ___________________________________ Event/Current Date(s): _____________ Chairperson/From: __________________________________________________________________ Budget Category(ies): ________________________________________________________________ If funds include more than $100 cash, please provide a signature from a second “counter” below. Coins

__________ __________ __________ __________ __________ __________

X X X X X X

.01 .05 .10 .25 .50 1.00

=$ =$ =$ =$ =$ =$

_____________.____ _____________.____ _____________.____ _____________.____ _____________.____ _____________.____

$

_____________.____

=$ =$ =$ =$ =$ =$ =$

_____________.____ _____________.____ _____________.____ _____________.____ _____________.____ _____________.____ _____________.____

Total Currency:

$

_____________.____

Total Cash (Coins and Currency):

$

_____________.____

$ $

_____________.____ _____________.____

Total Checks and Money Orders*:

$

_____________.____

Total All Funds

$

_____________.____

Total Coins: Currency

__________ __________ __________ __________ __________ __________ __________

Checks Money Orders

X X X X X X X

__________ __________

1.00 2.00 5.00 10.00 20.00 50.00 100.00

Totaling: Totaling:

# of rolls = # of rolls = # of rolls = # of rolls = # of rolls = # of rolls =

______ ______ ______ ______ ______ ______

*List all checks and money orders on back of form.

Verification: The undersigned certify these funds were received and properly accounted for. Signature: _______________________________ Signature: ________________________________ Credit/Debit Charges: (Attach report from payment vendor)

$ __________._____

For Treasurer’s Use Only Total funds received: $___________.____ Received:

____/____/____

Treasurer’s Signature: __________________________

Deposited:

____/____/____

Logged:

____/____/____

Check Number

Name

Amount $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $