The Gordon R. Irlam Charitable Foundation

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2022-12-24
Purpose: Quarterly expense report
Reference: 2022-GRICF-04

Date Category* Description Amount
2022-10-01    Health    Insurance   $823.00
2022-10-03    Health    Dentist   $290.00
2022-11-01    Health    Insurance   $823.00
2022-12-01    Health    Insurance   $823.00
Total expenses   $2759.00
Less advances   $0.00
Reinbursement due   $2759.00

* - 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: