PETTY CASH FUND RECONCILIATION
Department ____________________________________________________ Date of Report ______________________ Cash On Hand Currency
Coin
100 50
Dollar
20
Half Dollar
10
Quarter
5
Dime
2
Nickel
1
Penny
Total
0.00
Total
0.00
0.00 Cash Total $ ______________________
Disbursement Receipts on Hand
Pending Reimbursement
Total
Total
0.00 Disbursement Total $ ______________________
Fund Summary Petty Cash Fund Issued
Notes
Cash Total (-) Disbursement Total (-) Difference
0.00
If cash difference, contact Cashier’s Office.
__________________________________________________________________________________________________________________________________________
Cash Custodian (Signature)
Print Name
Date
__________________________________________________________________________________________________________________________________________
Supervisor (Signature)
Print Name
Date Version: 05.26.10
