Petty cash statement

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DGE-1100-VA (09-04)
Act respecting elections and referendums
in municipalities
Petty cash statement
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Name of the independent candidate or the party
Date of the invoice
yyyy-mm-dd
No of
voucher
Name of the person in charge
Name of supplier
Date of the statement
Date
Year
Month
Nature of electoral expenses
Day
Amount ($)
Total of expenses:
Amount(s) of the petty cash:
Balance:
Summary of electoral expenses by nature
Publicity ($)
Goods and services ($)
Rental of premises ($)
Travel and meals ($)
Amounts not included in the
election expenses ($)
D