Sheet 1: Blank

	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	

		


		


		


		

 
		
		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		
USAGE INSTRUCTIONS
	
	

		


		


		


		


		


		


		


		


		


		


		


		


		
ID#
		


		


		


	
	

		

		F2 to enter name
		Name:
		
Dept:
		


		
Date:
		
August 9, 2022
		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		
AUTOMOBILE TRAVEL
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Date
		
Mileage
		
Destination
		


		


		


		


		
Business Purpose of Travel
		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		
AMOUNTS
		


		


	
	

		


		


		


		
Tolls:
		


		


		


		


		


		


		


		


		


		


		


		
cents per mile
	
	

		


		


		


		
Total Miles @ $0.50: Mileage Expense
		


		


		


		


		

 
		
		


		


		
0.50
	
	

		


		


		
OTHER TRAVEL (Attach receipts; if air, you must attach ticket stub)
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		
Kind of
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Date
		
Travel
		
Destination
		


		


		


		


		
Business Purpose of Travel
		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


	
	

		
Date
		
OVERNIGHT ACCOMODATIONS (Attach Itemized Bills)
		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		
Nights
		


		


		


	
	

		


		


		
    "
		


		


		


	
	

		


		


		
    "
		


		


		


	
	

		


		


		
    "
		


		


		
per diem
	
	

		


		


		
   PER DIEM (2-3 meals)
		


		


		


		
days @ $45.00
		


		


		

 
		
		


		


		
45.00
	
	

		


		


		
   PER DIEM (1 meal)
		


		


		


		
days @ $22.00
		


		


		


		


		
22.00
	
	

		


		


		
   PER DIEM when entertained
		


		


		


		
days @ $15.00
		


		


		


		


		
15.00
	
	

		
For record Purposes only: List expenses relating to this Report which  were already charged to general ledger account or your corp credit card 
		
Date
		
OTHER REPORTABLE EXPENSES (Attach Receipted Bills)
		


		


		


		


		


		


	
	

		


		
$
		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Reimbursement must be submitted within 60 days of incurring expense or 
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
returning from trip, or it may be considered taxable income by the IRS.
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
PLEASE NOTE:  Prior to submitting this report, you need to obtain the approval
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
signature of your appropriate Department Head/Academic Dean/Vice President.
		


		


		


		


		


		


		


		
*TOTAL REIMBURSABLE EXPENSES
		
$0.00
		


		


	
	

		
We recommend that you always keep a copy for your files.
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
REMARKS/BILLING INSTRUCTIONS (IF ANY)
		


		


		


		


		


		


		


		
Please fill in CHARGE #s & AMOUNTS
		


		


	
	

		


		
Fund
		
Org.
		
Acct.
		
Prog
		
Activity
		


		


		


	
	

		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


	
	

		
I HEREBY CERTIFY THAT THESE SUBMITTED EXPENSES REPRESENT CASH SPENT FOR LEGITIMATE
		


		


		


		


		


		


		


		


	
	

		
COMPANY BUSINESS AND INCLUDES NO ITEMS OF A PERSONAL NATURE.  I UNDERSTAND THIS 
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
AMOUNT DUE TO ME MAY BE REDUCED IF I HAVE AN OUTSTANDING BALANCE WITH THE UNIVERSITY
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Signed:    ____________________________________________
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
                Employee Signature
		


		


		


		


		
Date
		


		


		


		


		


		


		


		


		


	
	

		
I HEREBY CERTIFY THAT THESE EXPENSES HAVE BEEN REVIEWED BY ME AND ARE FOR
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
LEGITIMATE BUSINESS PURPOSE AS IT RELATES TO OUR DEPARTMENT
		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Approved: ____________________________________________
		


		


		


		


		


		


		


		
TOTAL REPORTABLE EXPENSE
		


		


		


		


		
$0.00
		


		


	
	

		
                   Department Head/Academic Dean/Vice President        Treasurer
		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		
* This amount may be reduced if there is an outstanding balance due to the university.
		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Attach ORIGINAL, itemized receipts showing detail of purchase and method of payment.  Label each with business purpose and acct # to charge.
		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
Do not submit Order Confirmations or Credit Card charge slip showing only the total as these are not adequate proof or enough detail of an expenditure