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RECEIPT/RECONCILIATION FORM CASH/GIFT CARD PO Date Check CARD Vendor: PIN AMOUNT I have received the Cash/Gift Card listed above, and have read and understand all procedures pertaining to the use of this Card as printed on the back of this form, and agree to abide by such guidelines.. Purchase Date Brief Description of Purchase Amount of Purchase Original Card Value Card Balance Balance of Card-can be forwarded to another Card Receipts/Reconciliation Form I have attached all original receipts pertaining to the purchases made with this card and have included any reimbursement necessary to the District for sales tax appearing on the receipts or for any receipts which were lost and are not attached..