Attachment to MEMORANDUM NO. 2004-13
PETTY CASH FUND REPORT
|Department: (1) Name||_____________________________||Department Acronym||___________|
|Please print name and phone number|
|Petty Cash Advances|
|General Fund||Other Funds (3)|
|Actual Cash on Hand||_____________||____________|
|Actual Cash in Bank||_____________||____________|
|Receipts for Expenditures on Hand||_____________||____________|
|Travel and Other Advances Outstanding||_____________||____________|
I have examined this report and any attachments and certify that it is correct. I have examined the use of this petty cash fund during this past year and certify that its use has been as prescribed by the State Accounting Manual - Imprest Petty Cash Funds except as indicated on an attachment.
Further (check one)
_____ The full authorized balance is still needed.
_____ $__________ is in excess of our needs and will be returned.
(1) Departments with a "consolidated" petty cash fund need send only one consolidated report, however, the portion of the fund of each sub-unit should be shown on an attached sheet.
(2) Explain any discrepancy between this total and the Authorized Balance.
(3) Please identify the sources of advances from other funds.Return to Memorandum 2004-13
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