(Type or print in ink) My home address (enter address below) Deliver my check to: Home address if requesting home delivery: City, State, ZIP Employee Name ID # School/Department 2020 Begin Date thru End Date Year Position MILEAGE (Enter district locations using mileage chart abbreviations) Date From To Round Trip (Y or N) Purpose Mileage Date From To Round Trip (Y or N) Purpose Mileage PARKING AND TOLLS (attach receipts) Total Miles x IRS Rate Per Mile $ 0.575 Date Purpose Location Amount Total Mileage: $ - Total Parking and Tolls: $ - TOTAL EXPENSE: $ - I (the employee) hereby certify under penalty of perjury that this is a true and correct claim fo...
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