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Received of Petty Cash Form Example
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Text in this example:
I, have either not received or misplaced a receipt totaling $ (printed name) (not valid over $25) This affidavit is submitted in lieu of original receipt and attests: No original receipt for this expense is available. The expense was incurred on behalf of: The item and amount of the expense are accurate. No reimbursement of this expense has been or will be sought or accepted from any other source. Description of expense: Claimant's Signature Date Approver's Signature Date File this affidavit with the other receipts. Claimant's Name Approver's Name Amount Vendor Name Date of Expense Received of Petty Cash