Sfn52163 2025

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The document is a Purchasing Card Record form used by the Office of Management and Budget in North Dakota. It is designed for cardholders to report purchases made with the state purchasing card, including details such as purchase date, vendor, items purchased, and costs. The form requires signatures for reconciliation and approval.

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Click ‘Get Form’ to open the sfn52163 in the editor.
Begin by entering your name in the 'Cardholder (Employee) Name' field as it appears on your payroll records.
Fill in the 'PURCHASE DATE' section with the date of each transaction, ensuring it aligns with your reporting period.
In the 'VENDOR' field, input the name of the vendor from whom you made purchases.
Specify the reporting period by entering the start and end dates in the 'For Reporting Period' section.
List all items purchased under 'ITEMS PURCHASED', detailing each item for clarity.
Check charges against this period's statement and enter costs in the 'COST' column next to each item.
Calculate and enter subtotals and totals in their respective fields at the bottom of the form.
Sign and date where indicated to confirm that all purchases have been reviewed and reconciled.
Finally, submit your completed form to your Agency Purchasing Card Administrator for approval.

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