The Gordon R. Irlam Charitable Foundation

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2018-10-15
Purpose: Quarterly expense report
Reference: 2018-GRICF-03

Date Category* Description Amount
2018-07-05    Health    Insurance   $658.00
2018-07-29    Health    Prescription   $20.00
2018-08-05    Health    Insurance   $658.00
2018-08-14    Health    Prescription   $30.00
2018-08-14    Health    Therapy   $630.00
2018-08-17    Health    Doctor   $25.00
2018-08-27    Health    Emergency room   $100.00
2018-09-05    Health    Insurance   $658.00
2018-09-12    Health    Doctor   $25.00
2018-09-15    Health    Prescription   $20.00
Total expenses   $2824.00
Less advances   $0.00
Reinbursement due   $2824.00

* - Valid categories: Grants, Travel, Pubs, Office, Health, Programs, Other
Travel includes conf./meetings, transport, car-$0.545/mile, lodging, M&IE

Signature:

Approved by: Manjula Jonnalagadda

Signature:

Date: