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Get Georgia Pta Verification Form

00 = X $20.00 = X $50.00 = X $100.00 = Total 2 $ Checks How many? (Attach itemized list) Total 3 $ Cash Box Reimbursement (change/petty cash) Total 4 $ Grand Total (Total 1 + Total 2 + Total 3 - Total 4) $ For Membership Dues Collection Only #_____ members @ $_________ (dues) = $_________+ donations $_________ - petty cash $__________= $_______________ Please note: This total should equal the above Grand Total. Verification: (signature of the two counters) The undersigned cer.

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