Fillable Ap Petty Cash Reimb Form 8.18 (California State University, Chico)

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Ap Petty Cash Reimb Form 8.18 (California State University, Chico)

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CALIFORNIA STATE UNIVERSITY CHICO
FINANCIAL SERVICES
ACCOUNTS PAYABLE
KENDALL HALL ROOM
208 CHICO, CA 95929-0243
530-898-6426
www.csuchico.edu/ap
Purpose: Use this form to process reimbursement for purchases under $150 per day/per vendor for
allowable items. Please scan completed form and supporting receipts and send to
accountspayable@csuchico.edu. For further information, please refer to the Campus Petty Cash
Procedures.
TO BE COMPLETED BY DEPARTMENT
Department: Ext. Zip: Reimbursement Amount: $
Description of Purchase:
PURCHASER
I certify that I have personally paid for the items identified above and that upon reimbursement they become University
property. If any items are returned, I will refund the appropriate amount to the University.
Payee:
Signature
Print Name
Date
STATE CHARTFIELD
$
Account Fund Dept. ID Program (Optional) Class (Optional) Amount
$
Account Fund
Dept. ID
Program (Optional)
Class (Optional)
Amount
$
Account Fund
Dept. ID
Program (Optional)
Class (Optional)
Amount
After emailing the scanned form and supporting receipts to accountspayable@csuchico.edu, please retain
the original documents and deliver to Cashiering (SSC 230) upon notification from Accounts Payable.
INTERNAL USE ONLY - CASHIERING
AP: Petty Cash Reimbursement Authorization Form Updated: September 2018
AUTHORIZATION
Appropriate Administrator/Staff as documented on the Financial Services Authorized Signature Form on file at Accounts Payable
Signature
Print Name
Cashier’s Initials:
Receipts turned in: $
Amount
Date
Signature of Clerk Receiving Receipts
Cash Disbursal:
$
Amount
Date
Signature of Person Receiving Cash
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Ap Petty Cash Reimb Form 8.18 (California State University, Chico)

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Completed 18 July 2020

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