Petty Cash Receipt Form

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					                                Petty Cash Receipt Form


To be used to reimburse an employee or student from a departmental Petty Cash Fund
after an authorized purchase has been made:


Date of Purchase:     _________________

Purchase amount (cannot reimburse tax on goods): $____________________________

Vendor:               _____________________________________________________

Item(s) purchased:    _____________________________________________________

Business purpose:     _____________________________________________________

_______________________________________________________________________

Index to be charged: _____________________________________________________

Supervisor approval: _________________________ __________________________
                            Signature               printed name



I have been reimbursed for the attached receipt:

___________________________________ ______________________________
            Signature                     Printed Name

___________________________________
            Date



I have reimbursed the above named person from the Petty Cash fund:

___________________________________ ______________________________
      Custodian signature                 Printed Name

___________________________________
            Date

				
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posted:2/17/2012
language:English
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