Expense Reimbursement Form printable pdf download

Expense Reimbursement Form

EXPENSE REIMBURSEMENT FORM

Salida School District R32J

PAYABLE TO:__________________________________________________

PURPOSE OF EXPENDITURE/TRAVEL

(include destination if travel)

_________________________________________________________________

REIMBURSEMENTS WILL NOT BE PAID WITHOUT THE ATTACHMENT OF PROPER

RECEIPTS. PLEASE SUBMIT THIS FORM NO LATER THAN ONE WEEK AFTER

INCURRING THE EXPENSE OR ONE WEEK AFTER RETURNING FROM A

CONFERENCE.

DATE

AMOUNT

MILEAGE

ITEM PURCHASED

(List “Meals” if meal reimbursement)

($)

(# of miles)

TOTALS 

BUDGET CODE

APPROVED BY

District pays $26.00 per day for meals (overnight trips only) or actual amount spent, whichever is less.

District pays .48 per mile for mileage (to and from conference site only), if a district vehicle was requested

and was not available. Mileage will not be reimbursed for employees who choose to drive their own vehicle

when a district vehicle is available.

I HEREBY CERTIFY THAT THE ABOVE IS A TRUE STATEMENT OF EXPENSES INCURRED BY ME IN

THE SERVICE OF SALIDA SCHOOL DISTRICT R32J.

_____________________________________________________

__________________________

Employee (payee) signature

Date

approved reimbursement amount:

rev. 03/15/17

Expense Reimbursement Form