Date of Request Click or tap to enter a date.

PEOPLE RECORD OF EXPENSES Employee First & Last Name

Method of Reimbursement Check ACH Transfer Other

Tag # Date Incurred Description Stock # Receipt Dept. to be GLM Amount ($) Comments
attached expensed 2 Paid
(Y/N)1 (Y/N)

1 MM/DD/YYYY Y/N Y/N

2 MM/DD/YYYY Y/N Y/N

3 MM/DD/YYYY Y/N Y/N

4 MM/DD/YYYY Y/N Y/N

5 MM/DD/YYYY Y/N Y/N

Total 0

Comments

Signature Signature Signature

1 All expenses over $25.00 must have receipt unless adequately explained. Fuel receipts regardless of amount must have receipt.
2 If the requesting party is not sure on department to be expensed, it is permissible to leave this blank and let Pay Central or accounting declare the department

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