(STUDY CENTER NAME) PETTY CASH COUNT RECONCILIATION FORM

(MONTH, YEAR)

Attach Reconciliation Summary and Detail Repor To use, fill in the cells that are boxed & shaded,
the rest is automatic!

Custodian:

Fund: Petty Cash

Ending Balance from Reconciliation 0.00

Section A Cash on Hand Section B

Count Euro Amount Summary:

Bills: Cash on Hand:
5 0 0.00 Bills 0.00
10 0 0.00 Coins 0.00
20 0 0.00
50 0 0.00 Total cash on hand 0.00
100 0 0.00
200 0 0.00 Receipt totals (not yet submitted) 0.00
500 0 0.00
0.00 Reimbursement Request(s) In process 0.00

Coins: Uncashed reimbursment check(s) 0.00

0.01 0 0.00
0.02 0 0.00 Total (G13 to G19) 0.00
0.05 0 0.00
0.10 0 0.00 Total amount in fund (G6) 0.00
0.20 0 0.00
0.50 0 0.00
1.00 0 0.00
2.00 0 0.00 Difference (should be zero) 0.00

0.00

Custodian Signature Date

Independent Verifier Signature Date

(it is a good idea for a supervisor or other

independent verifier to periodically count
the cash and verify the above reconcilaition)
TY CASH COUNT RECONCILIATION FORM

boxed & shaded,