South Pike School District THIS FORM CAN BE PAGE 2 OF THIS VOUCHER FOR REIMBURSEMENT OF EXPENSES INCIDENT TO USED FOR MORE THAN FORM MUST BE OFFICIAL TRAVEL ONE TRAVEL COMPLETED FIRST OCCURRENCE EMPLOYEE EMPLOYEE NAME: LOCATION: For mileage of privately owned automobile used by me for transportation and reimbursement for subsistence and other authorized expenses paid by me in the discharge of official duty as per itemized statement within: DATE(S) FROM: TO: AMOUNT CLAIMED FINANCE DEPARTMENT VERIFICATION USE ONLY FOR AMOUNT FOR AMOUNT MEALS* (SEE NOTE BELOW) MEALS (SEE NOTE BELOW) LODGING (ATTACH RECEIPTS) LODGING(ATTACH RECEIPTS) TRAVEL (PRIVATE AUTO) TRAVEL (PRIVATE AUTO) TRAVEL (PUBLIC CARRIER) TRAVEL (PUBLIC CARRIER) (ATTACH (ATTACH RECEIPTS) RECEIPTS) OTHER TRAVEL COST OTHER TRAVEL COSTS SUBTOTAL SUBTOTAL LESS:TRAVEL ADVANCE LESS: TRAVEL ADVANCE TOTAL CLAIMED (REFUND) TOTAL CLAIMED (REFUND) MUST ATTACH COPY OF APPROVED OUT-OF-DISTRICT TRAVEL REQUEST FORM CHECK HERE IF OVERNIGHT STAY SUBJECT TO ANY DIFFERENCE DETERMINED BY VERIFICATION, I CERTIFY THAT THE ABOVE AMOUNT CLAIMED BY ME FOR TRAVEL EXPENSES FOR THE PERIOD INDICATED IS TRUE AND ACCURATE IN ALL RESPECTS, AND THAT PAYMENT FOR ANY PART HAS NOT BEEN RECEIVED. Date Employee Signature Supervisor or Program Director Date Approval Finance Office Date Verification ACCOUNT CODE AMOUNT MAXIMUM MEAL REIMBURSEMENT RATES IN STATE Please go to the website for any additional information for out of state travel: Breakfast $9.00 Lunch $12.00
South Pike School District THIS FORM CAN BE USED FOR MORE THAN ONE TRAVEL OCCURRENCE VOUCHER FOR REIMBURSEMENT OF EXPENSES INCIDENT TO OFFICIAL TRAVEL PAGE 2 OF THIS FORM MUST BE COMPLETED FIRST EMPLOYEE NAME: EMPLOYEE LOCATION: For mileage of privately owned automobile used by me for transportation and reimbursement for subsistence and other authorized expenses paid by me in the discharge of official duty as per itemized statement within: DATE(S) FROM: TO: AMOUNT CLAIMED FINANCE DEPARTMENT VERIFICATION USE ONLY FOR AMOUNT FOR AMOUNT MEALS* (SEE NOTE BELOW) MEALS (SEE NOTE BELOW) LODGING (ATTACH RECEIPTS) LODGING(ATTACH RECEIPTS) TRAVEL (PRIVATE AUTO) TRAVEL (PRIVATE AUTO) TRAVEL (PUBLIC CARRIER) (ATTACH RECEIPTS) TRAVEL (PUBLIC CARRIER) (ATTACH RECEIPTS) OTHER TRAVEL COST OTHER TRAVEL COSTS SUBTOTAL SUBTOTAL LESS:TRAVEL ADVANCE LESS: TRAVEL ADVANCE TOTAL CLAIMED (REFUND) TOTAL CLAIMED (REFUND) MUST ATTACH COPY OF APPROVED OUT-OF-DISTRICT TRAVEL REQUEST FORM CHECK HERE IF OVERNIGHT STAY SUBJECT TO ANY DIFFERENCE DETERMINED BY VERIFICATION, I CERTIFY THAT THE ABOVE AMOUNT CLAIMED BY ME FOR TRAVEL EXPENSES FOR THE PERIOD INDICATED IS TRUE AND ACCURATE IN ALL RESPECTS, AND THAT PAYMENT FOR ANY PART HAS NOT BEEN RECEIVED. Employee Signature Date Supervisor or Program Director Approval Date Finance Office Verification Date ACCOUNT CODE AMOUNT MAXIMUM MEAL REIMBURSEMENT RATES IN STATE Please go to the website for any additional information for out of state travel: Breakfast $9.00 Lunch $12.00
travel%20reimbursement%202014.docx