A	B	C	D	E	F	G	H	I	J	K	L	M	N
1	ASB Mileage Report (Type or print in ink)
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3									My home address (enter address below)
4				Deliver my check to:
5				Home address if requesting home delivery:
6				City, State, ZIP
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8
9	Employee Name						ID #		School/Department
10							2019
11	Begin Date		thru	End Date			Year		Position
12	MILEAGE (Enter district locations using mileage chart abbreviations)
13	Date	From	To	Round Trip (Y or N)	Purpose		Mileage	Date	From	To	Round Trip (Y or N)	Purpose	Mileage
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28	PARKING AND TOLLS (attach receipts)							Total Miles		0.00	x IRS Rate Per Mile		$ 0.580
29	Date	Purpose		Location			Amount	Total Mileage:				$ -
30								Total Parking and Tolls:				$ -
31
32								TOTAL EXPENSE:				$ -
33	I (the employee) hereby certify under penalty of perjury that this is a true and correct claim for necessary expenses incurred by me and that no payment has been received by me on account thereof.
34	FQA:									Total - District Travel (58000)
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36
37												Total:	$ -
38	Employee Signature:									Date:
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40	Activity Advisor Signature:									Date:
41	ASB Treasurer Signature:										Date:
42	Primary Advisor Signature:										Date:
43	Student Rep Signature:										Date:
44
45	2019	$ 0.580
46	2018	$ 0.545
47
48	My home address (enter address below)
49	Athletics
50	Cascade High School