Attachment to:
Comptroller's Memorandum 2001-27
April 12, 2001
PETTY CASH FUND REPORT
| As of ___________ | ||
| Agency:(1) Name________________________________________ Number_____ | ||
| Contact Person: ______________________________________________ | ||
| Please print name and phone number | ||
| Fund: | Petty Cash Advances | |
| General Funds | Other Funds(3) | |
| Authorized Balance: | ||
| Actual Cash on Hand | ______________ | ______________ |
| Actual Cash in Bank | ______________ | ______________ |
| Receipts for Expenditures on Hand | ______________ | ______________ |
| Travel and Other Advances Outstanding | ______________ | ______________ |
| Total | ______________(2) | ______________ |
| I have examined this report and any attachments and certify that it is correct. I have examined the use of this petty cash fund during this past year and certify that its use has been as prescribed by the State Accounting Manual - Imprest Petty Cash Funds except as indicated on an attachment. | ||
| Further (check one) | ||
| _____ The full authorized balance is still needed. | ||
| _____ $__________ is in excess of our needs and will be returned. | ||
| _________________________ | _________________________ | |
| Signature | Title | |
(1) Agencies with a "consolidated" petty cash fund need send only one consolidated report, however, the portion of the fund of each sub-unit should be shown on an attached sheet.
(2) Explain any discrepancy between this total and the Authorized Balance.
(3) Please identify the sources of advances from other funds.
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