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PETTY CASH REIMBURSEMENT REQUEST

 

Please issue a FIS Check in the amount of $_______________* to replenish the Petty Cash Fund of:

 

________________________________ ............... _______________________
Name ............... Department

 

Receipts are attached for all monies expended. A purpose for the expenditure must be included on each receipt. The expenditures should be charged as follows:

 

Index #

Account #

Activity #

$ Amount

 

 

 

 

 

 

 

 

 

Expenditure Total $ ________________

* Total of expenditures must equal amount of FIS Check requested.

Supervisorís Signature: ___________________________ Date _____________

 2.4.99 hg

pettycashreim.doc

Western Oregon University Monmouth Oregon 97361 503-838-8201 FAX 503-838-8014