Petty Cash Voucher

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  PC #:
   
 
 
QUANTITY
ITEM
UNIT PRICE
AMOUNT
1
  
2
  
3
  
4
  
REQUESTOR
 


   
EMPLOYEE SIGNATURE:

__________________________________
I hereby certify that the above goods and/or services were received by and necessary for use of the State of California and that quantity and quality are as indicated.
  
  
AUTHORIZER
 
   
APPROVED SIGNATURE:

__________________________________
 
  
  
PAID BY REVOLVING FUND
 
RECEIPT OF THE TOTAL AMOUNT SHOWN HEREIN IS HEREBY ACKNOWLEDGED
  
  

NOTE: Make sure values on form are correct as
VALUES ARE CLEARED BEFORE PRINTING AND FORM IS REFRESHED!