Request for Reimbursement Justification Form	PURCH-330B 4-1-04
This justification form must be completed, signed by the appropriate supervisors, and attached to the Request for Reimbursement form for all requests on which the total amount requested exceeds the maximum allowable amount of $ 250.00
Item Purchased
Justification for exceeding maximum limit of $ 250.00
Signature (not stamped)	Date
Signature of Supervisor	Date
Signature of Project
Director (If purchase is	Date
made from grand funds)
Signature of Administrator	Date