EXAMPLE LA Promise Fund Expense Report
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LA PROMISE FUND EXPENSE REPORT
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Date submitted:
April 7, 2017TYPE (check box)
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Write check to:First Name Last Namex
Reimbursement request
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Mail to (address):1234 Address St.Check to vendor
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Unit 111
Credit card expense accounting
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City, State, Zip
Petty cash accounting
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DateVendor NameItem & Purpose (specify program)Amount
Code Description
Acct. CodeProgramLocationGrant Code
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4/7/2017Sarah GomezMileage reimbursement for Girls Build LA Expo on 5/13/17$2.43
Student/Parent Transportation
64300
38 - Girls Build LA
HQ
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Total:$2.43
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Employee Name (Print):Rhea TrinanesApproved:Approved:
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Employee Signature:
Date:Date:
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Date:
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