Johns Hopkins University - Hopkins Medicine
Johns Hopkins University
Accounts Payable Shared Services – Petty Cash Unit
Petty Cash Action Form
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PART I: ESTABLISH FUND
Statement of Purpose: ___________________________________________________________________
________________________________________________________________________
______________________________________ ______________________________________________
Department Name Project Name and Funding Agency (if applicable)
______________________________________ ______________________________________________
Room & Building (if applicable) Off-Campus Location of Remote Funds (if applicable)
Business Area: _________________________ Operating Fund: ________________________________
______________________ Check One: Cash Till Domestic Checking Remote Checking
Amount Requested
______________________________ _________________ ________________ __________________
Print Custodian Name Telephone # Employee I.D. E-mail Address
___________________________________________ ________________________ _______________________ __________________________
Print P/C Administrator Name Telephone # Employee I.D. E-mail Address
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PART II: CHANGE FUND
Increase Amount of Fund Decrease Amount of Fund
Change in Administrator or Custodian (requires B-34) Change in Cost Center or Internal Order
Change in Location Other
Cash Journal # and/or Bank Account Name: ____________________ P/C General Ledger #: __________
Prior Information: ___________________________ New Information: ___________________________
Prior Information: ___________________________ New Information: ___________________________
Explanation: ___________________________________________________________________________
______________________________________________________________________________________
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PART III: CLOSE FUND
Cash Journal # and/or Bank Account Name: ____________________ P/C General Ledger #: __________
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______________________________ ___________ _____________________________ ___________
Custodian Signature Date P/C Administrator Signature Date
______________________________ ___________ _____________________________ ___________
Divisional Business Office Approval Date A/P Petty Cash Unit Processor Date
All Petty Cash changes and closing of fund, except change in location, require a reconciliation of the fund (B-34) and the signature of the Petty Cash Custodian and Petty Cash Administrator. To ensure a quick turn around, the form should be faxed (443-997-4636) to Accounts Payable Shared Services; although, a paper copy through the mail will be accepted.
Accounts Payable Shared Services – Petty Cash Unit
Johns Hopkins @ Keswick
3910 Keswick Road, Ste. N4300
Baltimore, MD 21211
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