The Gordon R. Irlam Charitable Foundation

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2021-07-01
Purpose: Quarterly expense report
Reference: 2021-GRICF-02

Date Category* Description Amount
2021-04-05    Health    Insurance   $770.00
2021-05-05    Health    Insurance   $770.00
2021-05-13    Legal    Annual meeting   $1700.00
2021-05-22    Health    Prescription   $39.13
2021-06-05    Health    Insurance   $770.00
2021-06-17    Health    Periodontist   $173.00
Total expenses   $4222.13
Less advances   $0.00
Reinbursement due   $4222.13

* - Valid categories: Grants, Travel, Pubs, Office, Health, Programs, Other
Travel includes conf./meetings, transport, car-$0.575/mile, lodging, M&IE

Signature:

Approved by: Manjula Jonnalagadda

Signature:

Date: