7/29/06 2:00 PM State Street UMC

State Street United Methodist Church
Disbursement Voucher

Pay to:

___________________________________________________

Address:

___________________________________________________

___________________________________________________

Amount:

___________________________________________________

From Budget Line Item:

___________________________________________________

For:

___________________________________________________

Requested by:

___________________________________________________

Date:

__________________________

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

FOR OFFICE USE ONLY

Amount Paid: _________________

Check No. ___________

Date Paid: ________________