The University of Chicago

Financial Services

  

How to Complete a Petty Cash Receipt

Petty cash receipt form
1. No. – Enter the sequential number assigned by the custodian of the petty cash fund. Note:This number is assigned and controlled by the custodian.

2. Date – Enter the date that the petty cash receipt is prepared.

3. Pay To – Enter the name of the payee who received the petty cash disbursement.

4. $ (Dollar Amount) – Enter the total amount of the payment.

5. Description – Enter a brief, but specific explanation of what the funds were used for. Note: Do not use “out-of-pocket expenses”.

6. Account Number – Enter the appropriate FAS 10-digit account number(s).
7. Dept. Ref. No. – This is an optional field used by the department only. It does not print on the FAS reports.

8. Amount – Enter the chargeable amount(s) associated with the 10-digit FAS account number(s) recorded in Field 6.

9. Authorized By and Date – The signature of the authorized signer of the account(s) to be charged and the date the petty cashed receipt was signed. Note: The “Authorized By” field must contain a handwritten signature; signature stamps or the authorized signer’s initials are not acceptable.

10. Above Amount Received By – Recipient’s signature and the date the cash was received. Note: The “Signed” field must contain a handwritten signature; signature stamps or initials are not acceptable.

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