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

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2009-09-30
Purpose: Quarterly expense report
Reference: 2009-GRICF-03

Date Category* Description Amount
2009-07-06    Health    Insurance   $341.00
2009-07-06    Health    Prescription   $70.00
2009-07-06    Health    Prescription   $70.00
2009-07-14    Health    Therapy - 2 sessions   $220.00
2009-08-05    Health    Insurance   $341.00
2009-08-13    Health    Dentist   $140.00
2009-08-18    Health    MedicAlert membership   $27.00
2009-09-03    Travel    Foundation annual meeting - 98 miles
  780 Wildcat Canyon Rd -
  2021 The Alameda, San Jose - return  
$53.90
2009-09-08    Health    Insurance   $341.00
2009-09-10    Health    Doctor   $25.00
2009-09-10    Health    Prescription   $10.00
2009-09-24    Health    Group   $12.00
2009-09-29    Accounting    Annual meeting   $500.00
2009-09-29    Health    Therapy (10 x $110)   $1100.00
Total expenses   $3250.90
Less advances   $0.00
Reinbursement due   $3250.90

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

Comments:

Signature:

Approved by: Purobi Phillips

Signature:

Date: