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r; Petty Cash Request ~m~'d <br />Person requesting cash (Print) <br />, AT. <br />Supervisor's approval <br />t: <br />Request for Reimbursement <br />(To fequest advance, use next box.) <br />4. <br />Date Custodian's intials t <br />Expenditures` Emplo sig ature <br />Request for Advance of Fund <br />(To request reimbursement, use previo s box.) <br />Date Custodian's intials _ <br />Amo loyee's initials <br />Ex Pdu u t dian's ini tials <br />Mon yee's signature <br />AmoLi %a <br />to employee <br />Vendor and Item Purchased <br />Acco <br />R-.dM97 -TOTAL: <br />