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6 <br />w <br />FOODS <br />Elgene, Oregon <br />Store h{.)03:9 <br />' ~ <br />Petty Cash Request <br />, <br />✓ <br />k <br />VY <br />~ <br />1 _ <br />Person requesting cash (Print) _ <br />c~v <br />Supervisor's approval - <br />Request for Reimbur ent <br />(To request advance, use next box.) <br />Date ' k" 1' 10- Custodian's intials <br />s 0' -7 <br />' <br />Expenditure <br />pi yee <br />sign re <br />Request for Advance of nds <br />i <br />(To request reimbursement, use <br />evious box.) <br />Date _ C odi Dn,4,,,ls <br />Amount E' loy s <br />Expenditures C odi ls <br />Money returned Employee's signature <br />Amount due <br />to employee <br />Vendor and Item Purchased • <br />Cashier: KIM .4. <br />01/13/10 <br />15:46:26 <br />2 0 3.:38 <br />CHIPWD TRAY MED 411:3024Fi44 <br />76. <br />7 <br />SOLID BLUE-H,'C 18100713002 <br />" <br />. <br />2 <br />28 <br />A/G SPICE 9 Jl E615266011. <br />43 <br />, <br />2.28 <br />3 0 2.28 <br />NAB C/AH CCH1'P g4000C,1796 <br />6 <br />84 FS <br />5 0 01") <br />. <br />BAG REFUND 5104 N1- <br />- -.30 <br />2 0 5.:'.i8 <br />VAR CHZ TRAY 8823199910 <br />11 <br />16 FS <br />RED OVAL WHEAT, 44000C3F:-3:8 <br />. <br />2.98 FS <br />3.94 lb 0 1 It, ! 2.98 <br />GRAPES, RED S/l- 4023 <br />11.74 FS <br />LOW/FAT TRISAff 4400000067 <br />2.74 FS <br />5.01 lb 0 1 1t 2:.98 <br />GRAPES.GREEN S/L 102:2 <br />14 <br />93 FS <br />KETTLE CHP L1 5 8411403238 <br />. <br />2.68 FS <br />shultz pretzals 70273,2'0204 <br />1.68 FS <br />2 @ 1.:98 <br />LANGER CRANBRY 4175500810 <br />3.96. FS <br />SUBTOTAL <br />73.41 <br />TOTAL TAX <br />.00 <br />TOTAL 73.41 <br />DEBIT CARD TINDER 73.41 <br />Acct: xxxxx?cxxkxxxO186 `S <br />APPRVL CODE <br />CASH CHANGE; OOl <br />NUMBER OF ITEMS 0.13 <br />18 <br />Account Codes <br />33b G353 --44 ~-~ti53~Z $ D.73 <br />- - - - $ <br />Revi 0697 TOTAL: <br />01/13/10 Oiler # 119941 `Tr-x- # 169 <br />15:47:14 Term # 11 Store #0039 <br />THANK YOU FCR SHOPPING AT WINCO <br />(5-41)463-1109 <br />***********'*1:*******, **Y:*:t************** <br />H1 i nCc) is odds <br />`,-l ' car'e:a 44 0039 <br />Electronic Payment Activity <br />M Acct : x;;)o(xxxx;cx.~(:x0186 <br />01/13/10 ; 15:17:0£,, <br />DEBIT Ref#10:1137 Auth# <br />Term# 11 RM00 Oper#119941 <br />DEBIT C' (R0 41 <br />Cash 0 <br />[Pa DD <br />01/13/10 Og)er # 119541 Trx # 169 <br />15:47:14 T;rm # 11 Store #0039 <br />THANK YOU FCR SHOPPING AT WINCO <br />(541) 463-1109 <br />