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

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2019-04-02
Purpose: Quarterly expense report
Reference: 2019-GRICF-01

Date Category* Description Amount
2019-01-01    Health    Prescription   $20.00
2019-01-07    Health    Insurance   $674.00
2019-02-05    Health    Insurance   $674.00
2019-02-11    Health    Dentist   $224.00
2019-03-05    Health    Insurance   $674.00
2019-03-07    Health    Prescription   $40.00
2019-03-25    Health    Doctor   $25.00
Total expenses   $2331.00
Less advances   $0.00
Reinbursement due   $2331.00

* - Valid categories: Grants, Travel, Pubs, Office, Health, Programs, Other
Travel includes conf./meetings, transport, car-$0.58/mile, lodging, M&IE

Signature:

Approved by: Manjula Jonnalagadda

Signature:

Date: