Student Administrative Services Center

                                   PETTY CASH VOUCHER

I authorize _____________________________ to be reimbursed funds for the purchase of:

_________________________________________________________________________.

(List and attach original receipts)

at a cost of $____________ to be used in ________________________________________.

                                                                                                                                            (Department Name)

Please charge account ____________________________________.

                                                            Authorized Signature  ________________________

Received Payment:  _______________________________  Date:  ____________________

                                               (Signature of authorized person requiring reimbursement)

Paid by:  _____________________________________

                                         (Authorized Personnel)

*Please note:  Petty Cash reimbursement cannot exceed $25.00 per person, per line item each day.  An ORIGINAL

receipt MUST accompany each request unless it is for reimbursement for University mileage.  A mileage expense is

expected to be reimbursed without a receipt.