GOLDEN ARCHES DEVELOPMENT CORPORATION ACCRUAL FORM (to be accomplished by DH) For the year ended December 31,

2012

Department: Submitted by: Signature: Date Received by Finance:

Invoice Number Date

Reference/ PO #

Description/Nature of Activity/Expense

Date of Activity/Expense/ Estimated Completion Date

Amount

Department/Store to Charge

Supporting Document

G&A

(Please add additional space if necessary)

TOTAL

CAPEX

(Please add additional space if necessary)

TOTAL