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

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2012-07-13
Purpose: Quarterly expense report
Reference: 2012-GRICF-02

Date Category* Description Amount
2012-04-04    Health    Group   $240.00
2012-04-05    Health    Prescription   $70.00
2012-04-05    Health    Insurance   $472.00
2012-04-09    Health    Prescription   $20.00
2012-04-04    Health    Doctor   $25.00
2012-04-25    Health    Dentist   $165.00
2012-05-02    Health    Group   $180.00
2012-05-05    Health    Insurance   $472.00
2012-05-14    Health    Doctor   $25.00
2012-06-05    Health    Insurance   $472.00
2012-06-06    Health    Group   $180.00
2012-06-15    Legal    Annual meeting   $1700.00
2012-06-21    Filing fees    Statement of Officers   $20.00
2012-06-30    Health    Therapy (10 x $170.00)   $1700.00
Total expenses   $5741.00
Less advances   $0.00
Reinbursement due   $5741.00

* - 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: