
Petty Cash Voucher 
Instructions: 
  1) You may only be reimbursed if your department does not have a petty cash fund. 
  2) The original receipt(s) must accompany the voucher. 
  3) Maximum amount reimbursable is $100. 
  4) The person receiving the funds must sign this form and present photo ID. 
  5) You may not receive reimbursement for the following: 
    a) Personal Services (All 1XXX account numbers) 
    b) Travel (All 2XXX account numbers, except Mileage on 2006) 
    c) Contractual Services accounts 3005 – 3013 
    d) Food Items filed with a Rep Allowance form 
    e) Capital Expenditures (All 5XXX account numbers) 
    f) Student Aid (All 6XXX account numbers) 
    g) Entertainment Items (Account 8115) 
 
See Accounting and Administrative Manual  
 
Paid to: ___________________________________________________________________ Date: __________________ 
 
Department: __________________________________ Box # __________________ Phone # _________________ 
Description Fund Org Account Amount 
Total Funds 
Signature of Payee: _______________________________________________________ Date: __________________ 
 
Approving Signature: ____________________________________________________ Date: __________________