A	B	C	D	E	F	G	H	I	J	K	L	M	N
1	Mileage Report (Type or print in ink)
2
3
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
11	Begin Date		thru	End Date			Year		Position
12	MILEAGE
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
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	Account Code:						-8001				Total - In District Travel
35	Account Code:						-8002	Total - Out of District Travel
36	Account Code:						-8003				Total - Out of State Travel
37												Total:
38	Employee Signature:									Date:
39
40	Employee Supervisor Signature:									Date:
41
42	Budget Authority Signature*:										Date:
43	(*Required if different than employee Supervisor)
44
45	2017	$ 0.535
46	2016	$ 0.540
47
48	My home address (enter address below)
49	Athletics
50	Cascade High School
51	Cedar Wood Elementary School