The Gordon R. Irlam Charitable Foundation

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2024-07-01
Purpose: Quarterly expense report
Reference: 2024-GRICF-02

Date Category* Description Amount
2024-04-01    Health    Insurance   $855.73
2024-04-01    Health    Insurance   $1014.00
2024-04-09    Health    Dentist   $250.00
2024-04-09    Health    Prescription   $37.99
2024-04-17    Health    Dentist   $200.00
2024-05-01    Health    Insurance   $855.73
2024-05-01    Health    Insurance   $1014.00
2024-05-12    Health    Prescription   $39.13
2024-06-01    Health    Insurance   $855.73
2024-06-01    Health    Insurance   $1014.00
2024-06-11    Health    Doctor   $25.00
2024-06-30    Health    Medical supplies   $18.32
Total expenses   $6179.63
Less advances   $0.00
Reinbursement due   $6179.63

* - 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: