Petty Cash Form

Petty cash MUST be preapproved by your Fiscal Analyst BEFORE purchase
Tax will not be reimbursed, bring tax exempt form with you when you purchase – Click here for Tax Exempt Form

Fiscal - Petty Cash Form

To comply with City Code, state below why petty cash was used vs. bid/storeroom/etc.

Your Full Name

Division

Item Purchased

Amount Owed

(Please DO NOT include tax)

Attach Receipts - No Tax Permitted

Maximum file size: 8MB

Please enter your Grant Number OR General Fund DAX String below (Click here for the DAX Conversion Listing)

Order will not be processed without correct fiscal information.

Grant #

G50XXXX

Fund #

i.e. 2250, 2251, etc

Program

i.e. CW001, HE002, etc

Section 3

i.e. 500XXX

Section 4

i.e. HE09, HE27, etc

Please double check email address spelling for accuracy. Notifications will be sent to email addresses to request signatures.

Employee Signature - Please sign before submitting form

Supervisor's Email

Full Typed Name - Supervisor

Date

Supervisor Signature

Fiscal Analyst's Name

Fiscal Analyst's Email

Full Typed Name - Fiscal Analyst

Date

Fiscal Analyst Signature

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