The Gordon R. Irlam Charitable Foundation

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2021-10-01
Purpose: Quarterly expense report
Reference: 2021-GRICF-03

Date Category* Description Amount
2021-07-05    Health    Insurance   $770.00
2021-08-05    Health    Insurance   $770.00
2021-08-16    Health    Prescription   $39.13
2021-09-05    Health    Insurance   $770.00
2021-09-23    Health    Periodontist   $351.00
2021-09-29    Health    Periodontist   $1242.00
2021-09-30    Health    Prescription   $11.99
Total expenses   $3954.12
Less advances   $0.00
Reinbursement due   $3954.12

* - 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: