Cash:

  $50.00                        Quarters   

  $20.00                        Dimes      

  $10.00                        Nickels    

  $  5.00                        Pennies    

  $  1.00   

                                                                                                                                                   Subtotal    [A]

  Receipts:

                              Vendor                        Date                Amount

  1.       

  2.       

  3.       

  4.       

  5.                                             Subtotal    [B]

  Reimbursement vouchers submitted for processing but not yet received:

               Date submitted                Amount                       Document No.

  1.               

  2.                                       Subtotal    [C]

                                                                Total Cash, Receipts and Reimbursement Vouchers             [D=A+B+C]

                                                                                                          Approved Petty Cash Fund            [E]

                                                                                                                       Overage/<Shortage>*         [F=D-E]

  Signature:

  Custodian:                                                                  Date:                                      

  * In the event of an overage or shortage, please contact the Budgets & Accounting Manager for assistance.

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