A	B	C	D	E	F	G	H	I	J	K	L	M	N
1	Mileage Report (Type or print in ink)
2
3									My home address (enter address below)
4				Deliver my check to:
5				Home address if requesting home delivery:
6				City, State, ZIP
7
8
9	Employee Name						ID #		School/Department
10							2025
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
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28	PARKING AND TOLLS (attach receipts)							Total Miles			x IRS Rate Per Mile		$ 0.700
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 - In District Travel (58581)
35	FQA:								Total - Out of District Travel (58582)
36	FQA:								Total - Out of State Travel (58583)
37												Total:	$ -
38	Employee Signature:									Date:
39
40	Employee Supervisor Signature:_______________________________									Date:		_____________________
41	Budget Authority Signature*:									Date:
42	(*Required if different than employee Supervisor)
43
44
45	2024	$ 0.670
46	2025	$ 0.700
47
48	My home address (enter address below)
49	Athletics
50	Cascade High School
51	Cedar Wood Elementary School
52	CRC - Accounting