Receipt Reconciliation Form

Expenses

Expense Detail(s)*
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ie Dinner for IAFF convention, New Apple computer, Coffee for meeting w/ Fire Chief
Upload Receipt(s)

Cancelof
Vendor for lost or missing receipt
Lost or missing receipt information
Please describe the circumstance of the lost or missing receipt.
Signature: I certify that the expenses and receipts submitted are accurate, complete, and were incurred for authorized Local 1159 business purposes in accordance with applicable policies and procedures. I understand that submission of false, incomplete, or misleading information may result in disciplinary action and/or repayment of funds as permitted by law and policy. Any accounts not reconciled are subject to being suspended until reconciliation. By signing below, I acknowledge responsibility for the accuracy of this reconciliation and confirm that all supporting documentation has been provided.
Should be Empty: