Fillable FS 005 Petty Cash Replenishment Banner Form (Idaho State University)

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FS 005 Petty Cash Replenishment Banner Form (Idaho State University)

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Idaho State University Petty Cash Replenishment Form
Page__1__of____
Date Vendor Description Department Index # Account Code Activity Code Amount
1
2
3
4
5
6
7
8
9
10
(A) Total From Supplemental Sheets
Acct # Summary
Amount
(C) Total Reimbursement
Requested
(D) Cash on Hand
(E) Total
(C plus D)
(F) Authorized Fund Balance
Custodian's Signature: __________________________________________________________________
Date:____/____/20____
(G) (OVER)/SHORT
(F minus E)
Charge amount on line (G)
Acct. Director/Dept. Head Signature: ___________________________________________________________________
Date:____/____/20____
to Index # _________________________
INSTRUCTIONS: This form is to be used to request reimbursement for expenditures made from an authorized petty cash
fund.
1. Using the information from the petty cash receipts enter the required data for each column by account number in the
spaces
provided on the form(s). Total the amount column on line B, including supplemental sheet(s) as required.
2. Summarize and group this information by account number and amount in the spaces provided in the Acct # summary.
3. The detail total on line B should agree to the Total Reimbursement Requested on line C.
4. The "Total Reimbursement Requested," together with the amount of "Cash on Hand" should equal the total balance of
the
authorized Petty Cash Fund amount.
5. The request should be signed by the fund custodian and approved with an authorized signature for the accounts
charged.
6. If more than one form is required, attach additional forms noting how many pages were used in the upper right hand
corner.
7. Forward the original of this form, together with original receipts grouped by account # in the same order as listed, to th e
University
(B) Total Amount
FS-005
Rev October 2014
UBO Signature: ___________________________________Date:____/____/20____
0.00
0.00
0.00
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FS 005 Petty Cash Replenishment Banner Form (Idaho State University)

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Completed 24 July 2020

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