Equipment / Rec Room Deposit Log

PETTY CASH RECEIPT AND AGREEMENT

Property: Employee Name: Petty Cash Amount: $ Date:

I, ______, hereby acknowledge receipt of an accept full responsibility for Petty Cash

issued to me this ______day of ______, 20 _____, by Monarch Properties, Inc.

______“Company”, in the amount of

______dollars ($______).

I agree to be personally responsible for the repayment of such amount, less any disbursements authorized by the “Company”, upon demand.

I further agree to forfeit and hereby assign the “Company” any wages or other sums which may be payable to me by the “Company” in an amount sufficient to repay this Petty Cash (less any disbursements authorized by the “Company”) if I am not able to fully account for such Petty Cash to the “Company’s” satisfaction upon demand. I further hereby consent to and authorize the “Company” to withhold any wages or other sums payable to me by the “Company” and to apply such monies toward repayment of any shortage in the Petty Cash for which I am responsible under this Agreement, upon demand by the “Company”. I further agree to pay all costs of collection of my obligation to repay unauthorized shortages in such Petty Cash, including but not limited to attorney’s fees and court costs, and I agree to pay interest on any shortages in the Petty Cash for which I am responsible under this Agreement at a rate equal to the commercial prime rate charged from time to time by the NCNB Texas Bank of Dallas, Texas, calculated from the date the “Company” demands repayment of such shortage.

I further waive any exemptions, claims or other defenses which I might be otherwise entitled to raise against the seizure, garnishment or withholding of wages and others sums payable to me by the “Company” pursuant to this Agreement under Federal and/or ______State Law.

By my signature affixed hereon, I acknowledge receipt of and accept responsibility for the Petty Cash amount specified, subject to the terms and conditions specified above.

Employee Date: Signature: Witnessed Date: By:

Cash Control Records Office Use Only Check Number: Check/Cash Amount: Date Issued: Amount Returned: Date Returned: Shortages:

1 of 1 Petty Cash Receipt and Agreement (09/09) MO-5 Received By: Date:

2 of 1 Petty Cash Receipt and Agreement (09/09) MO-5