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California State University Long Beach

Petty Cash Disbursement Voucher

Detailed Instructions

Select Business Unit
Chartfield Information

I hereby certify that this expenditure is necessary for the department's operation and the University's mission.

I hereby authorize the designee, whose name is listed below, to pick up reimbursement (optional).

Received by:

Signature Date Amount

Disbursed by:

For cashier's office use only: Signature   Date  

Form rev. 01-2022