PETTY CASH VOUCHER 
................................................................................. 
Department/Agency 
 
................................................................................. 
Division 
 
No…………………..……................................. 
 
Date………………………………………………… 
Amount…………………………………………… 
 
Purchase Description: 
………………………………………………………………………………..………………………………………………………………………….............
.………………….………………………………………………………………………………………..............………..……………………………………
…………………………………………………………………………………………………………………………………………………………………… 
…………………………………………………………………………………………………………………………………………………………………… 
 
I HEREBY CERTIFY THAT GOODS AND/OR SERVICES IN THE AMOUNT  
STATED ABOVE WERE PURCHASED ON BEHALF OF THIS DEPARTMENT/                        
AGENCY AND THE GOVERNMENT OF THE VIRGIN ISLANDS IN ACCORD-     
ANCE WITH APPLICABLE RULES AND REGULATIONS SUPPORTING DATA 
ARE ATTACHED. 
 
 
 
 
 
 
 
 
……………………………………….………….….. 
 
 
 
 
 
 
 
 
         Custodian 
 
(Fill in and sign when it is impractical to obtain a receipt) 
 
I HEREBY CERTIFY THAT THE AMOUNT OF $.................................... 
WAS PAID TO    ---------------------------------- 
FOR 
 
---------------------------------- 
ON 
 
---------------------------------- 
BUT NO RECEIPT COULD BE OBTAINED. THIS PUCHASE WAS 
MADE ON BEHALF OF THE DEPARTMENT/AGENCY AND THE 
GOVERNMENT OF THE VIRGIN ISLANDS IN ACCORDANCE 
WITH APPLICABLE RULES AND REGULATIONS. 
 
…………………………………………………… 
 
       Custodian 
 
 
ACCOUNT CODE 
ORG 
OBJECT 
PROJECT