| Submitted by: | Gordon Irlam |
| Date: | 2017-09-21 |
| Purpose: | Quarterly expense report |
| Reference: | 2017-GRICF-03 |
| Date | Category* | Description | Amount |
|---|---|---|---|
| 2017-07-05 | Health | Insurance | $628.00 |
| 2017-07-17 | Health | Dentist | $239.00 |
| 2017-08-05 | Health | Insurance | $628.00 |
| 2017-08-17 | Health | Therapy | $195.00 |
| 2017-08-22 | Health | Prescription | $20.00 |
| 2017-08-23 | Health | Dentist | $50.00 |
| 2017-09-05 | Health | Insurance | $628.00 |
| 2017-09-07 | Health | Prescription | $20.00 |
| 2017-09-14 | Health | Therapy | $195.00 |
| 2017-09-21 | Health | Periodontist | $170.00 |
| Total expenses | $2773.00 | ||
| Less advances | $0.00 | ||
| Reinbursement due | $2773.00 | ||
| * - Valid categories: | Grants, Travel, Pubs, Office, Health, Programs, Other |
| Travel includes conf./meetings, transport, car-$0.54/mile, lodging, M&IE |
Signature:
| Approved by: | Manjula Jonnalagadda |
| Signature: | |
| Date: |