| 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: |