The Gordon R. Irlam Charitable Foundation
23 Coronado Ave
Los Altos, CA 94022

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2017-12-21
Purpose: Expense report correction
Reference: 2017-GRICF-05

Date Category* Description Amount
2017-12-21    [Health]    2017-GRICF-01 correction
  2017-02-23 therapy not expensed  
$195.00
Total expenses   $195.00
Less advances   $0.00
Reinbursement due   $195.00

* - Valid categories: Grants, Travel, Pubs, Office, Health, Programs, Other
Travel includes conf./meetings, transport, car-$0.535/mile, lodging, M&IE

Signature:

Approved by: Manjula Jonnalagadda

Signature:

Date: