The Gordon R. Irlam Charitable Foundation

Expense report / Reinbursement request

Submitted by: Gordon Irlam
Date: 2024-12-31
Purpose: Quarterly expense report
Reference: 2024-GRICF-04

Date Category* Description Amount
2024-10-01    Health    Insurance   $855.73
2024-10-01    Health    Insurance   $1014.00
2024-10-02    Health    Doctor   $25.00
2024-10-08    Health    Dentist   $350.00
2024-11-01    Health    Insurance   $855.73
2024-11-01    Health    Insurance   $1014.00
2024-11-17    Health    Prescription   $38.67
2024-12-01    Health    Insurance   $855.73
2024-12-01    Health    Insurance   $1014.00
Total expenses   $6022.86
Less advances   $0.00
Reinbursement due   $6022.86

* - 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: