Petty Cash Fund Agreement
Finance Department
Stage
Initial
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
Finance Approver
Finance Approver
Initial Funds
Additional Funds
Name Change(s)
Total Funds $
Date:
PETTY CASH/CHANGE FUND AGREEMENT
Petty Cashier Name
Assistant Petty Cashier Name
Requesting Petty Cash or Change Fund
Petty Cash
Change Fund
Receipt Amount
I, [pettycash] as Petty Cashier and I, [assistantpettycashier] as Assistant Petty Cashier, hereby acknowledge the receipt of $ [dollaramount].
Are you the Petty Cashier:
Yes
No
Petty Cashier Lookup:
Petty Cashiers Email
Print Name
Petty Cashier Signature:
Assistant Petty Cashier Lookup:
Assistant Petty Cashiers Email
Print Name
Assistant Petty Cashiers Signature:
It is agreed that the receipt of these funds constitutes an obligation to operate the fund in strict compliance with the Petty Cash and Change Funds Policy and Procedures
(Policy #320.4)
, as approved by the Board of County Commissioners of Larimer County, Colorado.
Department Head Lookup:
Department Head Name Printed:
Department Name:
Department Head Email:
Department Head Signature:
Finance Approval Signature
Date:
Finance Use Only:
Account Coding
Fund Name
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