UNIVERSITY OF PITTSBURGH FORM INSTRUCTION GUIDE
FORM NUMBER: FORM 0046
FORM TITLE: Petty Cash Voucher
EFFECTIVE DATE: April 1, 2005
PAGE (S): 1
PLEASE PRINT LEGIBLY IN INK OR TYPE.
Refer to University Policy 05-06-06 for detailed instructions.
1. Name of Petty Cash Fund – Enter the name of the Petty Cash Fund.
2. SITE ID – Enter the SITE ID.
3. Date – Enter the current date.
4. Department – Enter the department name.
5. Purchased From – Enter the vendor name(s).
6. Account Number – Enter the appropriate 32-digit account number(s) to be charged for
7. Description of Expenses – Enter a brief description of the item(s) purchased. This
form is restricted to emergency expenditures. All purchases must be in accordance
with University Petty Cash Policy 05-06-06.
8. Amount – Enter the amount of each purchase.
9. Total – Enter the total of the amount(s) entered in the Amount column.
10. Name of Petty Cash Custodian – Enter the name of the Petty Cash Custodian.
11. Name of Recipient – Enter the name of the recipient.
12. Signature of Recipient – Obtain the signature of the recipient and include the check
number if the recipient was reimbursed by check.
13. Date – Enter the date the reimbursement is received (must be completed by the
14. Name of the Department Administrator – Enter the name of the person authorized to
approve purchases made to the account(s).
15. Signature of Department Administrator – Obtain the signature of the person
authorized to approve purchases made to the account(s).
16. Phone Number – Enter the campus phone number of the Department Administrator.
(The Administrator may be called to verify his/her
authorization of the purchase.)
17. Date – Enter the date the Department Administrator signed the Petty Cash Voucher.
Staple the original receipts(s) to the back of the form. Copies will not be accepted.