The Gordon R. Irlam Charitable Foundation
1723 Karameos Dr
Sunnyvale, CA 94087

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2005-12-31
Purpose: Quarterly expense report
Reference: 2005-GRICF-04

Date Category* Description Amount
2005-10-05    Health    Insurance - October   $195.00
2005-10-06    Compensation    Treasurer   $200.00
2005-10-06    Compensation    Secretary   $100.00
2005-10-10    Health    Prescription   $713.00
2005-10-12    Health    Dentist   $52.00
2005-10-12    Health    Dentist   $8.00
2005-10-14    Travel    To/from airport - 35 miles
  2836 Mayfied - CLE - return  
$14.18
2005-10-14    Travel    UAEM conference - snack   $4.18
2005-10-14    Travel    UAEM conference - bus fair   $14.00
2005-10-14    Travel    UAEM conference - metro fair   $10.00
2005-10-15    Travel    UAEM conference - dinner (no receipt)   $16.00
2005-10-16    Travel    UAEM conference - snack   $6.35
2005-10-16    Travel    Parking   $21.00
2005-10-20    Health    Psychiatrist   $120.00
2005-11-01    Health    Dentist   $56.00
2005-11-03    Health    Flu shot   $30.00
2005-11-04    Health    Psychiatrist   $240.00
2005-11-07    Health    Insurance - November   $195.00
2005-11-29    Health    Dentist   $60.00
2005-12-05    Health    Insurance - December   $195.00
2005-12-31    Health    Lab   $80.00
2005-12-31    Accounting    Accounting fee for annual meeting   $437.50
Total expenses   $2767.21
Less advances   $0.00
Reinbursement due   $2767.21

* - Valid categories: Grants, Travel, Pubs, Office, Health, Programs, Other
Travel includes conf./meetings, transport, car-$0.405/mile, lodging, M&IE

Comments:

Signature:

Approved by: Marantha de Araujo

Signature:

Date: 2005-12-31