| Submitted by: | Gordon Irlam |
| Date: | 2012-12-31 |
| Purpose: | Quarterly expense report |
| Reference: | 2012-GRICF-04 |
| Date | Category* | Description | Amount |
|---|---|---|---|
| 2012-10-05 | Health | Insurance | $472.00 |
| 2012-10-20 | Health | Health condition journal | $250.00 |
| 2012-10-24 | Health | Dentist | $165.00 |
| 2012-10-24 | Health | Prescription | $90.00 |
| 2012-11-05 | Health | Insurance | $472.00 |
| 2012-12-05 | Health | Insurance | $472.00 |
| 2012-12-09 | Health | Group | $420.00 |
| 2012-12-31 | Health | Therapy (10 x $170) | $1700.00 |
| Total expenses | $4041.00 | ||
| Less advances | $0.00 | ||
| Reinbursement due | $4041.00 | ||
| * - 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: |