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Petty Cash Request <br /> Person requesting cash (Print) ~ <br /> ~_?~rl__~/~7~~7°~ _ <br /> Supervisor's approval <br /> Request for Reimbursement <br /> (To request advance, use next hox. ) <br /> Date ~~z~~J~__ Custodian's intials _ _ _ _ <br /> Expenditures ~ Employee's signature <br /> Request for Advance of Funds <br /> ITo request reimbursement use previous box. I <br /> Date _ - Custodian's intials . <br /> Amount Employee's initials _ _ <br /> Expenditures _ _ _ Custodian's initials _ <br /> Money returned Employee's signature <br /> Amount due <br /> <br /> to employee <br /> Vendor and Item Purchased <br /> <br /> 3 33 - y3~ Z -la/ Y ~ O - 9~ 5~~~` <br /> Account Codes <br /> S <br /> ~ <br /> TOTAL: ~ <br /> /y <br /> ~ <br /> u v <br /> s~ <br /> <br />