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

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2013-09-27
Purpose: Quarterly expense report
Reference: 2013-GRICF-03

Date Category* Description Amount
2013-07-05    Health    Insurance   $526.00
2013-08-05    Health    Insurance   $526.00
2013-08-15    Health    Prescription   $90.00
2013-08-22    Health    Group   $232.50
2013-09-05    Health    Insurance   $526.00
2013-09-27    Health    Therapy (5 x $170; 4 x $185)   $1590.00
Total expenses   $3490.50
Less advances   $0.00
Reinbursement due   $3490.50

* - 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: