| Submitted by: | Gordon Irlam |
| Date: | 2011-12-31 |
| Purpose: | Quarterly expense report |
| Reference: | 2011-GRICF-04 |
| Date | Category* | Description | Amount |
|---|---|---|---|
| 2011-10-05 | Health | Prescription | $20.00 |
| 2011-10-05 | Health | Insurance | $426.00 |
| 2011-10-05 | Health | Group | $180.00 |
| 2011-10-05 | Health | Doctor | $25.00 |
| 2011-10-20 | Health | Health condition journal | $250.00 |
| 2011-10-26 | Health | Periodontist | $113.00 |
| 2011-10-31 | Health | Doctor | $25.00 |
| 2011-10-31 | Health | Lab | $10.00 |
| 2011-10-31 | Health | Prescription | $28.25 |
| 2011-11-01 | Health | Prescription | $8.00 |
| 2011-11-02 | Health | Group | $120.00 |
| 2011-11-05 | Health | Insurance | $426.00 |
| 2011-12-05 | Health | Insurance | $426.00 |
| 2011-12-07 | Health | Group | $180.00 |
| 2011-12-07 | Health | Periodontist | $1250.00 |
| 2011-12-07 | Health | Prescription | $53.17 |
| 2011-12-13 | Health | Psychiatrist | $1500.00 |
| 2011-12-16 | Health | Prescription | $70.00 |
| 2011-12-21 | Health | Periodontist | $1250.00 |
| 2011-12-29 | Health | Doctor (depost) | $300.00 |
| 2011-12-31 | Health | Therapy (9 x $170) | $1530.00 |
| Total expenses | $8190.42 | ||
| Less advances | $0.00 | ||
| Reinbursement due | $8190.42 | ||
| * - Valid categories: | Grants, Travel, Pubs, Office, Health, Programs, Other |
| Travel includes conf./meetings, transport, car-$0.55/mile, lodging, M&IE |
Signature:
| Approved by: | Purobi Phillips |
| Signature: | |
| Date: |