PAY TO: (Person to receive advance)
I hereby authorize the above to receive and/or use funds to make purchases not to exceed $25.00; certify
that budgeted funds are available in the account indicated above to cover such purchases and that such
purchases are appropriate to be charged to the account number indicated above.
RECEIVED BY
CASH RECEIVED/DISBURSED BY
Student
BUDGET MANAGER AUTHORIZED SIGNATURE
RECEIPTS ATTACHED
DATE
DATE
UCM PETTY CASH VOUCHER
DOLLARS
Index Fund Organization Account Program Activity
Instructions:
1. Make sure the amount authorized has sufficient funds and does not exceed $25
2. T
ake the form to Student Financial Services for reimbursement along with the
original receipts. KEEP COPIES OF THE RECEIPT FOR YOURSELF.
COPIES WILL NOT BE ACCEPTED IN REPLACE OF ORIGINAL RECEIPTS!
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