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

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2018-04-02
Purpose: Quarterly expense report
Reference: 2018-GRICF-01

Date Category* Description Amount
2018-01-05    Health    Insurance   $658.00
2018-01-14    Health    Prescription   $20.00
2018-01-18    Health    Therapy   $195.00
2018-02-05    Health    Insurance   $658.00
2018-02-14    Health    Doctor   $25.00
2018-03-05    Health    Insurance   $658.00
Total expenses   $2214.00
Less advances   $-195.00
Reinbursement due   $2409.00

* - Valid categories: Grants, Travel, Pubs, Office, Health, Programs, Other
Travel includes conf./meetings, transport, car-$0.545/mile, lodging, M&IE

Signature:

Approved by: Manjula Jonnalagadda

Signature:

Date: