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STATE OF COLORADO <br /> Form 150. Expense Account - Miscellaneous Items <br /> Expenditure of: For Period Ending 19 <br /> G/L Acct.Ilo. <br /> Month of: S 'T Fly Month of: Month of: <br /> Item <br /> ------ ------- ------ ----- ----- <br /> x .-Ob ect' ----- ----- ------ ----- --- ----- ---- ----- <br /> DAY I <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 7 <br /> 8 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 1 <br /> 16 <br /> 17 <br /> 1 <br /> 19 <br /> 20 <br /> i:2P 21 8t <br /> t�Y 22 <br /> 23 t <br /> 24 <br /> 25 <br /> 26 <br /> 27 <br /> 28 <br /> 29 <br /> 30 <br /> 1 <br /> Totals <br /> Sub-total Sub-total <br /> Te1.Rc Tel, From To Amt. Sub-total <br /> From o From To <br /> _.Sub'Total <br /> 6 I hereby certify upon honor teat tie above i-swa <br /> G TQL&la-fo eriod �4 l true statement of expenses incurred by me in the <br /> Approve or payme t service of /� Department. <br /> Mail <br /> Warrant tg. �5�eyI t 409-" c G ._T �s 3 <br /> white: with receipts for voucher buff: employee copy (9ignature) (Address) <br /> 395.53-01.1501 <br />