Petty Cash Turn Over Rate:
Annual
Disbursements $_______________ = Turnover
________________ Rate
Dollar Level
Of Fund $
_____________________________________________________________ ____________________________________________________________
Signature of Custodian Signature of Responsible Official
C-18
Agency:_______________________________________________________________________________________
Address_______________________________________________________________________________________
Location of Fund________________________________________________________________________________
Amount of Fund $ _________________ Date_______________ Telephone Number __________________________
Calendar Number of Amount of
Year 20
____
Transactions Disbursements
January . . . . . . . . . . . . . . . . . . . . . .
February . . . . . . . . . . . . . . . . . . . . .
March . . . . . . . . . . . . . . . . . . . . . . .
April . . . . . . . . . . . . . . . . . . . . . . . . .
May . . . . . . . . . . . . . . . . . . . . . . . . .
June. . . . . . . . . . . . . . . . . . . . . . . . .
July . . . . . . . . . . . . . . . . . . . . . . . . .
August . . . . . . . . . . . . . . . . . . . . . . .
September. . . . . . . . . . . . . . . . . . . .
October . . . . . . . . . . . . . . . . . . . . . .
November . . . . . . . . . . . . . . . . . . . .
December . . . . . . . . . . . . . . . . . . . .
Total. . . . . . . . . . . . . . . . . .
Annual Petty Cash Fund
Usage Report
$
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
