- Use only for purchases totaling less than $150.00
- Within the box, or on attached page, securely mount original
receipts with tape. Do not overlap or cover other parts of form.
- Complete bottom part of form providing FULL ACCOUNTING UNIT
data and the four-letter OWNER CODE for your department.
- Completed form must be APPROVED BY person with the budget signature
authority or by person authorized to sign for purchases on budget's
associated Low Value Purchase Authorization.
- Internal controls, such as a separation of duties, should be
observed. Therefore, APPROVED BY person may not be same person
who receives payment.
- Retain copy of the form for department file.
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