ATLANTA POLICE DEPARTMENT

REQUEST FOR REIMBURSEMENT

Name:
SSN
Division/Section/Unit:	Phone:
Reimbursement amount requested (attach receipt):
Justification/Explanation:
Signature:
Date:

Approving Supervisor:

Position/title
Name

Signature:

Date:

FOR FISCAL USE ONLY

Are Funds Available?	Yes No

Fiscal Unit

Budget Manager:
Authorizing Signatures:
Corporate Services Section Commander:
Date:

Support Services Division Commander:
Date:
Amount Received by:

Name	Date

Form APD-704 revised 5/17/04

ATLANTA POLICE DEPARTMENT

AJordan

2004-05-17