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Northumberland County Government Petty Cash Receipt Funds

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					     Northumberland County Petty Cash Funds                            Yes   No N/A   Responsible Person   Comment

                                Petty Cash
a.   Is an imprest petty cash fund used?
b.   Is one person independent of accounting procedures solely
     responsible for maintaining the petty cash fund?
c.   Are petty cash vouchers:

          1. Required for each petty cash disbursement?

          2. Prenumbered?
          3. Signed by the recipient?

          4. Executed in ink?

          5. Canceled after use?

d.   Are there written policies that cover limitations on the amount
     of disbursement, approval requirements and other restrictions?
e.   Are vouchers and supporting documents checked by a
     responsible employee at the time of the reimbursement?
f.   Are reimbursement checks made payable to the petty cash
     custodian?
g.   Are disbursement posted to appropriate expense
     classifications when the fund is replenished?
h.   Are surprise counts made at reasonable intervals?

i.   Are loans and personal check cashing activities strictly
     prohibited?
j.   Is the Petty Cash imprest amount periodically reviewed
     for reasonableness?
k.   Are discrepancies in the Petty Cash Reconciliation adequately
     investigated and resolved?
l.   Is supporting documentation required to be submitted with the
     Petty cash voucher prior to disbursement of petty cash funds to
     the requestor?
m.   Are petty cash funds kept in secure storage?

n.   Is the cashing of employee paychecks out of the petty cash
     fund prohibited?




                                                                                                       1
                                   Petty Cash Voucher Report
                                           Form 3710

I hereby certify that a cash audit was conducted this date ___________, on the Petty Cash
fund for (department name) __________________. Results are as indicated below.


                                                                             Totals
A. Authorized Amount                        ----------------------- $-------------------------------

B. Cash Value in Petty Cash
                  Cash on Hand
      Checking Account Balance
            Outstanding Checks
Stamps or other cash value items
                      B. Subtotal

C. Pending Reimbursement
   or Receipts on hand
                       Mileage              $
                         Tolls              $
                        Others




                          C. Sub-total

D. Petty Cash Reconciliation                                          $
   (Line “B” plus “C” = “A”)

Note: If line D does not equal Line “A”, you need to reconcile again. If there are corrective actions to
be taken, please explain below.

Petty Cash Custodian Signature: ________________________________________

Supervisory Approval:              ___________________________________________




                                                                                                           2
                                                (Sample)

                                   Petty Cash Voucher Report
                                           Form 3710

I hereby certify that a cash audit was conducted this date 6/25/96, on the Petty Cash fund
for (department name) Finance. Results are as indicated below.


                                                                               Totals
A. Authorized Amount                        -----------------------            $1,000.00------------

B. Cash Value in Petty Cash
                  Cash on Hand                  $750.00
      Checking Account Balance
            Outstanding Checks
Stamps or other cash value items
                      B. Subtotal                                               $750.00

C. Pending Reimbursement
   or Receipts on hand
                       Mileage              $
                         Tolls              $
                        Others                  $250.00




                          C. Sub-total                                          $250.00

D. Petty Cash Reconciliation                                                    $1,000.00
   (Line “B” plus “C” = “A”)

Note: If line D does not equal Line “A”, you need to reconcile again. If there are corrective actions to
be taken, please explain below.

Petty Cash Custodian Signature: ________________________________________

Supervisory Approval:              ___________________________________________




                                                                                                           3
                                Northumberland County Government
                                    Petty Cash Receipt of Funds
                                                  &
                                   Certification of Responsibility


Name of Department:_________________________________________________________________

Custodian:__________________________________________________________________________

Total Authorized Amount of Petty Cash Fund: $___________________________________________

Statement of Responsibility

I accept responsibility for the petty cash funds issued to me as Custodian. I have read the Northumberland
County Government Petty Cash Policy and agree to administer these funds in accordance with the Policy.
Should there be any shortage or disappearance of these funds, I understand that I must contact the
Department Head/Constitutional Officer immediately. I further understand that failure to comply with the
Policy could result in disciplinary action.



______________________________________                         _________________________________
          Signature of Custodian                                               Date



______________________________________                         _________________________________
Signature of Department Head/Constitutional Officer                            Date



__________________________________________                     _____________________________________
        Signature of Finance Department                                        Date


(Please return original to the Accountant, Finance Division)




                                                                                                             4
                                   Northumberland County Government
                                                   &
                                    Petty Cash Voucher/Advance Form

                                                                                Claim No.__________


Department:__________________________________                                   Date:______________


Employee Name:______________________________


Amount Disbursed from Petty Cash Fund            $______________________________________


General Ledger Account Number to Charge:________________________________________


Purpose: _____________________________________________________________________

_____________________________________________________________________________

______________________________________________________________________


If a Cash Advance:            a)       Amount Spent (submit receipts)   $_____________________
                              b)       Amount Cash Returned             $_____________________
                              c)       Total (a+b)                              $_________________
                              d)       Amount Due County                        $_________________
                              e)       Amount Due Employee              $_____________________



Dept. Director:      _________________________________________          ______________________________
                     Department Head/Constitutional Officer Signature           Date



Received By:         ________________________________________           ______________________________
                             Employee Signature                                 Date



Custodian:           ________________________________________           ______________________________
                             Custodian Signature                                Date




                                                                                                         5
                                Northumberland County Government
                                                &
                                 Petty Cash Reimbursement Request

Vendor Number:               _______________________               Cash________       Checking________


Department Name/Payable to:_________________________________________________


Book Balance                                                                        $_______________
Disbursements with Receipts                                                         $_______________
Disbursements without Receipts                                              $_____________
Petty Cash Established Balance                                              $_____________
*Should always equal the established funded amount

Cash Balance                                                                          $_______________


**Should always equal

Please allocate reimbursement as follows:

Cost Code #        _______________________________________________                    $________________

Cost Code #        _______________________________________________                    $________________

Cost Code #        _______________________________________________                    $________________

Cost Code #        _______________________________________________                    $________________

Cost Code #        _______________________________________________                    $________________

Cost Code #        _______________________________________________                    $________________

Cost Code #        _______________________________________________                    $________________

Total Expenses                                                              $___________________

I certify these expenses were incurred by the Department on official business of Northumberland County Government.

Custodian:_____________________________________________                     Date:___________________

Dept. Head/Constitutional Officer:__________________________                Date:___________________


PLEASE ATTACH NECESSARY RECEIPTS




                                                                                                                 6

				
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