The Gordon R. Irlam Charitable Foundation

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2023-10-06
Purpose: Quarterly expense report
Reference: 2023-GRICF-03

Date Category* Description Amount
2023-07-03    Health    Insurance   $897.00
2023-07-17    Health    Periodontist   $373.00
2023-07-18    Health    Prescription   $17.98
2023-07-18    Health    Prescription   $19.13
2023-07-30    Health    Insurance   $753.57
2023-08-01    Health    Insurance   $897.00
2023-08-31    Health    Insurance   $753.57
2023-09-01    Health    Insurance   $897.00
2023-09-05    Health    Prescription   $153.99
2023-09-05    Health    Prescription   $14.13
2023-09-11    Health    Doctor   $25.00
Total expenses   $4801.37
Less advances   $0.00
Reinbursement due   $4801.37

* - 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: