Certification of Expenses Not Requiring Receipts Certification of Expenses Not Requiring Receipts
Certification of Expenses Not Requiring Receipts Certification of Expenses Not Requiring Receipts
Certification of Expenses Not Requiring Receipts Certification of Expenses Not Requiring Receipts
(Agency Name)
TOTAL
Purpose
I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose, that above goods and services were
acquired from parties not issuing receipts. And that I am fully aware that willful falsification of statements is punishable by law.
Certified correct: Noted by:
Signature
Printed Name
Employee Immediate Supervisor
Date Date
ANNEX A
(Agency Name)
TOTAL
Purpose
I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose, that above goods and services were
acquired from parties not issuing receipts. And that I am fully aware that willful falsification of statements is punishable by law.
Certified correct: Noted by:
Signature
Printed Name
Employee Immediate Supervisor
Date Date