Attachment to Memorandum 2005-10
PETTY CASH FUND REPORT
As of ___________
| Department: | (1) Name_____________________________ Department Acronym______ |
| Contact Person: | ____________________________________________________ |
| Please print name and phone number | |
| Fund: | |
| Petty Cash Advances | ||
| General Fund | 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) Departments 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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