The Gordon R. Irlam Charitable Foundation

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2022-03-24
Purpose: Quarterly expense report
Reference: 2022-GRICF-01

Date Category* Description Amount
2022-01-05    Health    Insurance   $823.00
2022-02-05    Health    Insurance   $823.00
2022-02-27    Health    Prescription   $39.13
2022-03-02    Health    Dentist   $210.00
2022-03-05    Health    Insurance   $823.00
Total expenses   $2718.13
Less advances   $0.00
Reinbursement due   $2718.13

* - 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: