PETTY CASH FUND REPORT
As of ___________
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.
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