Form To Request Petty Cash

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FORM TO REQUEST PETTY CASH
MEMO TO:
_______________________________________
FROM:
_______________________________________
DATE:
_______________________________________
SUBJECT:
PETTY CASH REQUEST
I request that _______________________________ be authorized to establish a petty cash fund in the amount
(School / Fund Name)
of $________________ from account number _________________________________________________.
(Amount)
(Account Number)
Justification for the proposed use and estimated monthly dollar transactions is as follows:
_______________________________________________________________________________________________.
If approved, I certify that the petty cash fund will be operated in full compliance with the Clovis Municipal
Schools procedures for petty cash. The fund custodian will be _____________________________, _______________.
(Name of Person Responsible)
(Phone)
The designated alternate custodian to act in his/her absence is________________________________, _____________.
(Name of Person Responsible)
(Phone)
The cash and records for this fund will be located in ___________________________________________ and will
(Building and room)
safeguarded as prescribed in the above procedures. The funds and records will be available for any scheduled and/or
unannounced audit.
__________________________________________
Petty Cash Custodian Signature
__________________________________________
Principal/Department Head Signature
………………………………………………………………………………………………………………………………
DO NOT WRITE BELOW THIS LINE
□
□
Approved
Disapproved
Date of Board Meeting:________________ Board Member__________________
**For Petty Cash $100.00 or Over**
Approved
_________________________________
_____________________________
Supervisor of Finance Department
Date
Disapproved
_________________________________
_____________________________
Supervisor of Finance Department
Date
REMARKS:_____________________________________________________________________________________

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