T ~ ...................,....._~...,__.....-..».....w,„.,.~~ra, „ ~ ..o~ <br /> ~ , <br /> . } ~"'l~iiil~' ~';f t = ~ ~~xi~~~= • ~ f.:: Pe#~ Gash Re uest <br /> t ~ ~ ~ ~ Y ~ <br /> ~aa~~~~~ ~~I <br /> 14~: ~a ~ <br /> Person requesting cash ~Print~ <br /> f'~ E <br /> ~~~.}tai ~ Supervisor's approval ,,,r„~,._ <br /> i{~ "r ; <br /> s'"" ' • Request for Reimbursement <br /> (To request advance, use next box.) <br /> Date ~ ~ Custodian's intia s _ _ <br /> <br /> • ~ ~ ~ ~i~~`~.~s~ ~ Expenditures ~ ~ M~ _ Empla ee' nature ' <br /> Request fvr Advance of Funds <br /> ~ ~ (To request reimbursement, use previous box.) <br /> }^#i~ ~5~~r~~~~'~,~ Date Custodian's intiafs <br /> ~ y t#~ ~ ~ E Amount Employee's initials <br /> ~f ~~~~E~ ~;~t~°~~;,~'~4p ~~1~`~~;~~~ Expenditures Custodian's initials <br /> E i ~~~~~i~i <br /> i ~y3~~i~~i~" Money returned _ _ Employee's signature <br /> f ~''I ~E:: _.~`~"I i`~'~ Amount due <br /> ,i.; , ~ to employee _ <br /> ~ ~~'~~~~E~~~~ Vendor and Item Purchased <br /> . , <br /> Y <br /> r' <br /> • <br /> ,~i <br /> e <br /> s <br /> ~ <br /> fi <br /> P <br /> Petty Cas Re uest <br /> Person reques~i~'~g cash (Prints ~-t~t.• _ <br /> Supervi~vr's approva! <br /> k <br /> - Request far Reimbursement <br /> (To request advance, use next box.) <br /> 1 ~ <br /> Date ~ Custodian's intials <br /> ~EM~E~ #111755~682D0 Ex enditures <br /> p pio e' s'g tore f <br /> 7f ~~D? D~1 Q 41 D~ 15.9 ~ ~ <br /> TaT~L Request far Advance of Funds <br /> UC ~~T/aE~~T . ~ 5_•. (To request reimbursement, use previous box.) <br /> ~X~~X~~~~~{X~~ ~ SWIPED Date Custodian's intials <br /> 01122~'D9 ~~~~7 _ <br /> ~ ! Amount Empiayee's initials <br /> EFTIDE~IT :Re~~ : R~ Expenditures Custodian's initials ~ <br /> i •Money returned ~ Empbyee's signature <br /> Amount due <br /> ~f~PRa~IED ~ ~F ~ to employee <br /> AMQUNT ~ ,E 5. ~9 <br /> ~ Vendor and Item Purchased <br /> 00 ~ z 005 0000000 <br /> ~___...W.__.~__~._..W <br /> CHANSE . CO _ <br /> ~~UT~L ~~~l~1DER QF ITEMS SDLD ~ 1 . ~y,. ~ <br /> N. REG# 5 <br /> CASHIER R CHR~LES ~ ' ccount Codes <br /> '~[~~!~?~~~I!~a 1 ~ ~ ~7 D417 ~5 D 125 ~ _ ~ _ ~ _ ~ - - - - I'i <br /> ' y'. ~ti ~ II <br /> ` ~ ~ ~ C~ Nw1 ~ X19 ~ ~ <br /> r' <br /> _n_.. <br /> <br />