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

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2015-12-31
Purpose: Quarterly expense report
Reference: 2015-GRICF-04

Date Category* Description Amount
2015-10-05    Health    Insurance   $597.00
2015-10-22    Health    Therapy   $185.00
2015-10-30    Office    Postage   $19.99
2015-10-31    Filing fees    Statement of information   $20.00
2015-11-01    Health    Prescription   $40.00
2015-11-05    Health    Insurance   $597.00
2015-11-06    Accounting    Anual meeting   $383.38
2015-11-17    Health    Dentist   $206.00
2015-11-19    Health    Therapy   $185.00
2015-12-05    Health    Insurance   $597.00
2015-12-17    Health    Therapy   $185.00
Total expenses   $3015.37
Less advances   $0.00
Reinbursement due   $3015.37

* - Valid categories: Grants, Travel, Pubs, Office, Health, Programs, Other
Travel includes conf./meetings, transport, car-$0.56/mile, lodging, M&IE

Signature:

Approved by: Purobi Phillips

Signature:

Date: