Petty Cash Reimbursement Fill in Form - DOC - DOC by rst60617


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									                                                                                                   STATE OFFICE USE ONLY

                                                                                                  Date received:
                                                                                                  Date processed:

                                                                                                         Processor’s Initials

                                       Petty Cash Reimbursement
     1. Please fill out form completely. Make copies if you need more space for Part II.
     2. Please attach original receipt(s) and a copy of the check written (if available).
     3. Send to 4055 Arctic Warrior Drive, EAFB, AK 99506 using the Federal Express Acct. #247020896
     4. If this is an emergency please fax to (907)753-2192 with copies of receipt(s) and mail the original as soon
        as possible.


  PART I:                   Bank Account transfer to be made from:

  This section summarizes the monthly activity in your account. The ending balance is the amount you should have in
  your possession at the end of the month. Your account will be replenished monthly, as long as all receipts and
  reports are turned in. The State office will not replenish petty cash accounts automatically when a bank statement
  is received. This paper is necessary for replenishment.

  Beginning balance as of                     :

  Account replenishment from prior month:

  Expenses for month of                       :
  (detailed in section below – please include bank charges)

  Ending Balance as of                        :

  Part II: Expense Detail

  In this section report all uses of petty cash funds. Receipts must be attached for all expenses in order for your
  account to be replenished.

Date    Check #                       Vendor                         Amount      Expense Account               Class
                                                                                     to debit

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