The Gordon R. Irlam Charitable Foundation
1723 Karameos Dr
Sunnyvale, CA 94087

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2012-03-31
Purpose: Quarterly expense report
Reference: 2012-GRICF-01

Date Category* Description Amount
2012-01-01    Health    Prescription   $20.00
2012-01-02    Office    Domain name and web hosting   $57.26
2012-01-05    Health    Insurance   $472.00
2012-01-18    Health    Group   $240.00
2012-01-30    Health    Dentist   $154.00
2010-02-04    Accounting    Tax return   $2000.00
2010-02-04    Taxes    Tax return   $427.00
2010-02-04    Filing fees    Tax return   $60.00
2012-02-05    Health    Insurance   $472.00
2012-02-08    Health    Group   $180.00
2012-02-16    Health    Doctor   $336.00
2012-03-06    Health    Insurance   $472.00
2012-03-14    Health    Group   $240.00
2012-03-31    Health    Therapy (11 x $170)   $1870.00
Total expenses   $7000.26
Less advances   $0.00
Reinbursement due   $7000.26

* - Valid categories: Grants, Travel, Pubs, Office, Health, Programs, Other
Travel includes conf./meetings, transport, car-$0.55/mile, lodging, M&IE

Signature:

Approved by: Purobi Phillips

Signature:

Date: