The Gordon R. Irlam Charitable Foundation

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2021-03-28
Purpose: Quarterly expense report
Reference: 2021-GRICF-01

Date Category* Description Amount
2021-01-05    Health    Insurance   $770.00
2021-02-05    Health    Insurance   $770.00
2021-02-21    Health    Prescription   $39.13
2021-03-05    Health    Insurance   $770.00
Total expenses   $2349.13
Less advances   $0.00
Reinbursement due   $2349.13

* - Valid categories: Grants, Travel, Pubs, Office, Health, Programs, Other
Travel includes conf./meetings, transport, car-$0.575/mile, lodging, M&IE

Signature:

Approved by: Manjula Jonnalagadda

Signature:

Date: