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

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2018-12-23
Purpose: Quarterly expense report
Reference: 2018-GRICF-04

Date Category* Description Amount
2018-10-05    Health    Insurance   $658.00
2018-10-15    Health    Prescription   $20.00
2018-10-18    Taxes    Additional for 2014   $69.63
2018-10-22    Accounting    Annual meeting   $375.00
2018-10-26    Health    Doctor   $25.00
2018-10-29    Health    Doctor   $25.00
2018-11-05    Health    Insurance   $658.00
2018-11-05    Health    Periodontist   $422.00
2018-11-08    Health    Periodontist   $518.00
2018-11-14    Health    Periodontist   $127.00
2018-11-28    Health    Doctor   $25.00
2018-12-02    Health    Prescription   $20.00
2018-12-05    Health    Insurance   $658.00
Total expenses   $3600.63
Less advances   $0.00
Reinbursement due   $3600.63

* - 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: