No.

$

University of Pennsylvania
Petty Cash Voucher Slip
(Form C-2A Rev. 06/02) Date: 
For:


Charge to : - - - - - -

CNAC

ORG

BC

FUND

OBJC

PROG

CREF

ATTACH ALL APPLICABLE VOUCHERS AND RECEIPTS:

I approve that the expenditures above were incurred by the payee while on official University business, are accurate and that he/she is not requesting reimbursement from any other source.		I certify that the expenditures listed above were incurred by me for official University business, are accurate and that I am not requesting reimbursement from any other source. Upon signing below, I have now received reimbursement from the above fund.

_________________________________	__________________________________
Approved by	Received by

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