Systems and Procedures
A Division of The Corporate Controller's Office
IN

RECEIPT FOR PETTY CASH EXPENDED
FORM INSTRUCTIONS

Form Instructions

  1. Department Reference - Enter the internal department reference information such as fiscal year or any other relevant information.

  2. Date – Enter the date the Receipt for Petty Cash Expended was created.
  3. Table (a header row, seven columns, and five rows for data entry)

  4. Column 1 – Vendor - Enter name of the vendor from whom the petty cash purchase was made.

  5. Column 2 – Description of Purchase – Enter a description of the item purchased using petty cash funds.

  6. Column 3 – Budget # - Enter the 10 digit budget number to be charged.

  7. Column 4 – Fund # - Enter the six digit fund number to be charged.

  8. Column 5 – Object Class – Enter the four digit Object Class to be charged.

  9. Column 6 – Cost Center – Enter the 10 digit Cost Center number to be charged (if applicable).

  10. Column 7 – Amount – Enter the amount of the petty cash expenditure for this particular budget code.
  11. Provide the same information for the next four rows of the table (as applicable)

  12. Total – This field is locked and automatically calculates. No data entry is required.

  13. Print name – After reading the following statement the employee prints their name within this location:
  14. Employee who made purchases: I have been reimbursed for the purchases indicated above (on this form). I understand that this reimbursement is subject to final approval via the Special Request for Check (SRFC) used to replenish this petty cash fund.

  15. Signature - After printing the form, the employee signs within this location.

  16. Date - The date the form is signed is entered within this space.

  17. Budget Administrator - The purchase for which reimbursement has been made are in compliance with University policy. This reimbursement is subject to final approval via the Special Request for Check (SRFC) used to replenish this petty cash fund. The Budget Administrator signs within this location.

  18. Date - The Budget Administrator enters the date upon which they sign the form.

  19. Attach receipts within this area (use tape). If additional space is needed, attach receipt(s) by stapling to the back (one staple, upper left hand corner).
Image of Exhibit A - Receipt for Petty Cash Expended