Petty Cash Log Template

Petty Cash Log

Date of Request:

Check Payable To:

Mail Check to:

Beginning Cash

(Ending cash on hand from last Petty Cash Log)

Checks Received from OSI (Petty Cash reimbursement checks received since last Petty Cash Log submission)

Cash Paid Out (Amount of this request)

Ending Cash (Beginning cash on hand on next Petty Cash Log - Should equal actual cash on hand)

Date of

Office

Receipt

Brief

Amount

AP Code

Receipt

to Charge

Name

Description

(office use only)

Submitted by:

Doctor's Signature:

Note: All original receipts must be attached and form must be signed prior to processing.

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Parent category: Financial