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

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2019-12-24
Purpose: Quarterly expense report
Reference: 2019-GRICF-04

Date Category* Description Amount
2019-10-05    Health    Insurance   $674.00
2019-10-22    Accounting    Annual meeting   $375.00
2019-10-27    Filing fees    Statement of Information   $20.00
2019-11-05    Health    Insurance   $674.00
2019-11-10    Health    Prescription   $40.00
2019-11-21    Health    Periodontist   $156.00
2019-12-05    Health    Insurance   $674.00
Total expenses   $2613.00
Less advances   $0.00
Reinbursement due   $2613.00

* - 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: