0.00 I declare, penalty of perjury, that this claim is just, correct and that no part of it has been paid or reimbursed by the state of Minnesota or by another party except with respect to any Total amount to be reimbursed to the employee: advance amount paid for this trip. I AUTHORIZE PAYROLL DEDUCTION OF ANY SUCH ADVANCE. I have not accepted personal travel benefits. 0.00 Amount of Advance to be returned by the employee by deduction from paycheck: Employee Signature _________________________________________________ Date _____________________Work Phone: Approved: Based on knowledge of necessity for travel and expense and on compliance with all provisions of applicable travel regulations. Appointing Authority Designee (Needed for Recurring Advance and Special Expenses) Supervisor Signature __________________________________________ Date _______________ Work Phone: Signature ____________________________________________________________ Date ________________________
I declare, penalty of perjury, that this claim is just, correct and that no part of it has been paid or reimbursed by the state of Minnesota or by another party except with respect to any advance amount paid for this trip. I AUTHORIZE PAYROLL DEDUCTION OF ANY SUCH ADVANCE. I have not accepted personal travel benefits. Employee Signature _________________________________________________ Date _____________________Work Phone: Total amount to be reimbursed to the employee: 0.00 Amount of Advance to be returned by the employee by deduction from paycheck: 0.00 Approved: Based on knowledge of necessity for travel and expense and on compliance with all provisions of applicable travel regulations. Supervisor Signature __________________________________________ Date _______________ Work Phone: Appointing Authority Designee (Needed for Recurring Advance and Special Expenses) Signature ____________________________________________________________ Date ________________________