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,w..... <br /> m~ <br /> Petty Cash Request <br /> Person requesting cash ~Prinfiy~ ~f ~ ~ , <br /> Supervisor's approval <br /> . Request or Reimbursements <br /> . ~ (To request advance, use next box.) <br /> T i ~ket #9034 ~ 1 /2E/~009 .:.1 -k. ~ . <br /> ~ ~ Date ~ ~ ' <br /> g. ~ 3~car~. X000 Cl~r~. DP3 Custodian s intrais ~ <br /> ~~*~~~*~~~~;~~~~,t~;~;~:~,~~,~,~,~;~;~;~~,~,~~y~~~, : Expenditures Employee's si ature <br /> Full City.P~arl ~ <br /> ~ 84~ P~ar'~ S~tr~e~ <br /> * ~ ~ ' Request far Advance of funds <br /> ~4 ~ -3440475 ~ (Ta request rermbursemenf, use previous box.) <br /> . qty D~~Gi"z~~i~~. ~ Date Custodian's intials <br /> . W_= Priu~~ . <br /> Ob f~~c~s~ 1 ~ ~ , ~ G . 6~ Amount Ernplayee's ~r~~tiais <br /> ~ Expenditures ~ Gustodian's initials <br /> <br /> - ~i~h Tod Mane return d <br /> . y e ~ Employee s signature <br /> ~~X: Amount due <br /> ~Ci~ 1 ~t~~ : C5 to empiayee <br /> Ci ~ ~ ~~ard T~ri~a~ ~ _ <br /> ~ rp~ , <br /> i"~ <br /> d. <br /> r <br /> Card lV~~mb~r; <br /> ' ~ ~ ' ' ' ' ' ' ' ~ Vendor and Item Purchased <br /> wr <br /> ~V~i' <br /> f , , Y~r~~ desarve~ a ~PPAT cu ~ .4:. <br /> ~ o~ ca~fee~ <br /> E~ <br /> Account Codes <br /> . . <br /> ~I <br /> Revrsad X693 T TA <br /> o <br /> <br />