Petty Cash Request Form - University of Vermont

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Petty Cash Request Form - University of Vermont Powered By Docstoc
					                                               University of Vermont
                                         Request for Petty Cash (Open Item)

                                                                                           FR&AS Approval:

                                                                                           Employee ID: (OIK) enter all 7
Custodian                                                                                  characters in individual boxes

    Account       OP Un      Department         Fund            Source            Program         Purpose           Property

1 0 0 5                                       1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Department                                                                                 Phone

Office Address

Amount Requested $                                                                                 ( ) Cash            ( ) Check

Budget chartstring responsible for EXPENSES (required):      * Indicates Required fields for Grants..other budgets may not require all fields
*OP                                                  *PC Bus
 Un *Department *Fund          *Source   *Function      Unit           *Project          *Activity *An Type *Program *Purpose *Property

End-date if budget is a GRANT                m m d d y y y y

Purpose of Fund*
                                  Check one and then enter date: ( ) Indefinite (long term departmental use, no date
                                  required); ( ) If grant, indicate end date of grant; ( ) change fund or short term event-- needs
                                  last date of event.
Length of time needed
Average amount expected to be spent each
month for two replenishments                                        $
Plans for safeguarding the fund from theft:

In receipt of this petty cash, I as custodian, agree to accept as a personal liability the full value of this fund and will reimburse
the University of Vermont for any expenditure not documented by receipts. I further authorize the University to withhold, from
my paycheck, any outstanding petty cash amounts not deposited with the cashier or documented by receipt within the
time specified above, or at least monthly if this request is for a permanent petty cash fund. I have read and understand the
University's Petty Cash Policy.

                                                         (Custodian signature required )

Department Approval
                                                       (Chairperson, Dean, or Director signature required)

REMINDER: Vermont Sales Tax SHOULD NOT be paid since UVM is exempt from this tax. You can print the tax exempt
certificate from the General Accounting or Accounts Payable website or pick up a copy of the certificate in Purchasing,

Accounts Payable or General Accounting. A copy of this certificate is to be given to vendors when you make a purchase.                                revised 4/30/09

* If Petty Cash is for Research Subject payments it will need to be replenished or closed out before the end of the calender year for tax purposes,
along with a form containing the subjects Social Security #, printed name with signature, full legal address and the date and amount of payment.

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