1. Statement Of Travel Expenses





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      Statement Of Travel Expenses
      (Type or Print in Ink)
       
       

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      Name       School/Dept/Position      
       
      Destination       Purpose      
       
      Departed/Began Travel Status: Date:      
       
      Time:      
      Returned/Ended Travel Status: Date:      
       
      Time:      
       
      (Note: If you are claiming entitlement to all three meals in any one given day, you may claim the total per diem in the “Total for Day” column. If any meals are provided as part of registration expense, traveler should adjust meals claimed accordingly.)
      Total Day

      Per Diem

      In-State $ 61

      Out-of-State $ 66
      Date
      Incidentals

       

      In/Out-of-State $5
      Breakfast

       

      In-State/$10

      Out-of-State/$11
      Lunch

       

      In-State/$15

      Out-of-State/$16
      Dinner

       

      In-State/$31

      Out-of-State/$34
      TOTAL

      for Day
      First Day/

      Day 1
           
           
           
           
           
      $     
      Day 2
           
           
           
           
           
      $     
      Day 3
           
           
           
           
           
      $     
      Day 4
           
           
           
           
           
      $     
      Day 5
           
           
           
           
           
      $     
      Day 6
           
           
           
           
           
      $     
      Day 7
           
           
           
           
           
      $     
      SUBTOTAL
      		     
      $      
       
      *Hotel/Lodging  
           
      *Travel via Air or       (Omit if paid by District)  
           
       Personal Vehicle       Miles @      
      ¢ per mile  
           
      *Registration (Omit if paid by District)  
           
      *Other (please specify):        
           
      Deduct: Travel Advance  
      (     )
      * Itemized receipts must be attached .  GRAND TOTAL
      $     
       


      FOR ACCOUNTING OFFICE USE ONLY:

      ACCOUNT CODE:  

       

       

       

       

       





      I 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.

       

       

                

       Employee Signature    Date

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      Rev 07/10  Submit Signed Original to the Accounting Office   1.05c