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

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2019-09-15
Purpose: Quarterly expense report
Reference: 2019-GRICF-03

Date Category* Description Amount
2019-07-02    Health    Optometrist   $25.00
2019-07-02    Health    Prescription glasses   $120.85
2019-07-05    Health    Insurance   $674.00
2019-07-29    Health    Doctor   $25.00
2019-08-05    Health    Insurance   $674.00
2019-08-13    Health    Dentist   $160.00
2019-08-19    Health    Prescription   $45.00
2019-09-05    Health    Insurance   $674.00
2019-09-06    Health    Prescription   $20.00
Total expenses   $2417.85
Less advances   $0.00
Reinbursement due   $2417.85

* - 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: