PTC Reconciliation 010809

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					                                                                CITY OF LOS ANGELES - NEIGHBORHOOD COUNCIL FUNDING PROGRAM
                                                                       PETTY CASH EXPENDITURE QUARTERLY RECONCILIATION FORM
Instructions:     This form is for PETTY CASH Transactions ONLY. Please list each transactions CHRONOLOGICALLY. Please attach and submit the ORIGINAL RECEIPTS and INVOICES by pasting them on 8 1/2 by 11 paper. If write "NO
ACTIVITIES" on the form if no transactions occurred during this period,. Please Complete MISSING RECEIPT AFFIDAVIT when necessary. Please insure there are TWO SIGNATURES at the bottom of this form before final submission.

TREASURER NAME:(PRINT)                                            TREASURER PHONE NUMBER                     TREASURER E-MAIL                                      FISCAL YEAR          FROM…TO… (CALENDAR MONTH)

  DATE OF                                                                                                                                       VOUCHER                                      AMOUNT                 AMOUNT
                            VENDOR NAME                                                       DESCRIPTION                                                          BUDGET LINE
 PURCHASE                                                                                                                                        NUMBER                                      Credit ( - )           Debit (+)

                                                                BEGINNING PETTY CASH BALANCE (Please attach Cash Count Sheet if necessary)                                                                                  $0.00

                  U S BANK CASH WITHDRAW                                                                                                                                                                                    $0.00

                                                                TOTAL PETTY CASH INCREASED OF THIS PAGE                                                                                                                     $0.00
                                                                TOTAL PETTY CASH PAYOUTS OF THIS PAGE                                                                                                                       $0.00
                                                                ENDING PETTY CASH BALANCE OF THIS PAGE                                                                                                                      $0.00
                                                                ENDING PETTY CASH BALANCE OF THIS QUARTER

(1) I confirm and approve the purchase of the listed items and services using the Neighborhood Council       (2) I have verified these purchases. The items listed are for Neighborhood Council use only. The items are necessary,
Charge Card. Appropriate documentation is attached verifying the materials purchased, nature of service      are for Neighborhood Council use and have been purchased in compliance with the policies and procedures of the
and identifying the company or vendor, the total cost and including original receipts.                       Department of Neighborhood Empowerment.

RECONCILED BY                                                                  DATE                          RECONCILED BY                                                                             DATE
(Signature)                                                                                                  (Signature)
                             Neighborhood Council Treasurer                                                                                            Neighborhood Council Board Member

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