visa summary form

Page 1 of 2
VISA SUMMARY FORM
Card Holder
Name:
Date of Expense
as per statement
(mmm/dd/yy)
Dec/05/16
Scott Baerg
Expense Type
Visa Statement Date(MMM/DD/YYYY)
Purpose of Expense
Select from drop down Covenant Health Leaders
list
Retreat
Number
of guests
Jun/27/2016
Names of guests
Details
Bal Unit
Site
Functional Centre
Secondary Code
Amount ($)
Detailed
Receipt
attached
(Y/N) *
Other Agency /
Personal
expense (Y/N)**
J. Doe; J. Doe;
Eg. Vendor Name, LOS at Hotel,
Parking (No Valet) etc.
901
0020
71111111111
automatic
$250
Y
N
Jun/06/16
Hotel-Provincial
Attend Executive Education Program
in Calgary & meet with David O'Brien
(AHS)
Carriage House Inn (Calgary)
901
0020-Corporate
71110101085-VP
Operations Mental Health
Services
62312000-Travel Staff
Provincial
$151.19
Y
Jun/09/16
Hotel-Provincial
Attend Executive Education Program
in Calgary
Hotel Alma (Calgary) - accommodation
901
0020-Corporate
71110101085-VP
Operations Mental Health
Services
62312000-Travel Staff
Provincial
$740.98
Y
Jun/08/16
Parking-Provincial
Attend Executive Education Program
in Calgary
Impark
901
0020-Corporate
71110101085-VP
Operations Mental Health
Services
62312000-Travel Staff
Provincial
$14.00
Y
Jun/09/16
Parking-Provincial
Attend Executive Education Program
in Calgary
Hotel Alma (Calgary) - parking fee
901
0020-Corporate
71110101085-VP
Operations Mental Health
Services
62312000-Travel Staff
Provincial
$20.00
Y
Jun/09/16
Catering
Provide lunch for the members of the
Site Command Post for the EGCCC
flood
Panago Pizza
901
0020-Corporate
71110101085-VP
Operations Mental Health
Services
69600000-Meeting
Expense
$116.22
Y
TOTAL
$1,042.39
Amount
($)
Repayment
provided (Y/N)