Request for reimbursement of travel expenses

Request for Reimbursement of Travel Expenses

NORTH CAROLINA LIBRARY ASSOCIATION

    Name:_____________________________________________________________________               Date:   _________________

Address:    __________________________________________________________

__________________________________________________________

__________________________________________________________

 

Section, Round Table, Committee, etc.:________________________________________

Destination/Purpose of Trip(s):_______________________________________________

Time and date leaving:_________________ Time and date returning: ______________

Summary of Reimbursable Expenses (State rates for instate/out-of-state)

No of Each          Meal Rate

               Meals:Breakfast(s)      _________   x  $ 6.50/6.50      =    $____________

Lunch(es)           _________   x  $ 8.50/8.50      =    $____________

Dinner(s)            _________   x  $14.50/16.50    =  $____________

Type of Transportation:_________________________________________          $___________

Lodging (attach receipt): $55.50/66.00$___________

Registration (attach receipt):$___________

Mileage:  ___   miles    x   $0.36    =            $____________

Other:(Explain & attach receipts):                                                                                        $___________

  Total Due          $ __________

SUBMITTED FOR PAYMENT: ____________________________________________                   ______________________________

                              Signature of Requestor                                                                           Date

APPROVED FOR PAYMENT:                                                                                                                  ______________________________

                                                                  Signature of Chair or President                                                                Date

(Do not write in this space – For use by Treasurer only)

Check Number:                                               _                            Date:                                   ____________________________

Budget Code:                                                                           Signature of Treasurer:                                                                                                 

rev. 2003-05-20