The Gordon R. Irlam Charitable Foundation
326 A St
Redwood City, CA 94063

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2003-09-30
Purpose: Quarterly expense report
Reference: 2003-GRICF-03

Date Category* Description Amount
2003-07-02    Health    Psychologist   $125.00
2003-07-16    Health    Dentist   $150.00
2003-07-18    Health    Prescription copay   $35.00
2003-07-27    Health    Insurance - August 2003   $178.00
2003-08-01    Office    Office supplies   $92.91
2003-08-15    Office    2 Black ink cartridges   $61.53
2003-08-25    Health    Insurance - Sep-Dec 2003   $712.00
2003-08-29    Health    Dentist   $1637.00
2003-09-10    Health    Prescription copay   $35.00
various    Health    Group Therapy x 8   $160.00
various    Health    Psychologist x 8   $1080.00
various    Health    Psychiatrist x 3   $60.00
Total expenses   $3026.44
Less advances   $0
Reinbursement due   $3026.44

* - Valid categories: Grants, Travel, Pubs, Office, Health, Programs, Other
Travel includes conf./meetings, transport, car-$0.365/mile, lodging, M&IE

Comments:

Signature:

Approved by: Marantha de Araujo
Date: 2003-10-01
Signature: