Fill - Free fillable P- Card Missing Receipt Form.xlsx (City of Meriden (CT)) PDF form

PurchasingCard

MissingReceiptForm

PurchaserandVendorInformation:

Purchaser'sName:

Purchaser'sDepartment:

PurchaseDate:

VendorName:

Methodof Purchase: In‐Store Phone Internet Other:

AmountofPurchase:

DetailedDescriptionofEachItemPurchased:

Description Quantity UnitPrice TotalCost

Total

TheCityisexempt

fromsalestaxinmostinstances

Explanation:

ReasonforMissingReceipts:

OriginalReceiptLost NoReceiptwasGiven Other:

AdditionalExplanationorNotes:

Signatures:

Cardholder/Purchaser'sSignature: Date:

SupervisorSignature: Date:

Thisformistobecompletedasdocumentationonly

iftheactualitemizedreceiptisnotattainableforatransactionmade

withtheP‐Card.Useofthisforminlieuofanactualreceiptshouldbearareexception,nottherule.Usingtheformmore

thantwiceinanyfiscalyearmaybegroundsfordiscontinuinga

Cardholder'suseoftheP‐Cardorotherdisciplinaryaction.

Theformmustbefilledoutcompletely,signedbytheCardholderandbytheCardholder'sSupervisororCardManager.

IattestthattheabovepurchasewasmadeforthebenefitoftheCityofMeriden/PublicSchoolswhileconductingofficial

Citybusiness.IcertifythatIhaveattemptedtoobtainanoriginalreceiptfromthevendor.

KeepthisformwithyourotherPurchasingCarddocumentationinlieuoforiginalreceipt.

Note:Every

effortshouldbemadetoobtainanoriginalreceiptfromthevendor.

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P- Card Missing Receipt Form.xlsx (City of Meriden (CT))

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