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					                                               CINCINNATI COE
                                            EXPENSE REPORT FORM


COMPANY #41                 CINCINNATI REGION CHAPTER                                    MILEAGE RATE:             $       0.14


NAME:


    DATE         DEPT        ACCOUNT         PROJECT                   TRANSACTION EXPLANATION                         AMOUNT




SUBTOTAL                                                                                                                    -

                                            MILEAGE REIMBURSEMENT
    DATE         DEPT        ACCOUNT         PROJECT         NUMBER OF MILES            TRIP EXPLANATION               AMOUNT
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SUBTOTAL                                                                                                                    -


TOTAL                                                                                                                       -


             AUTO INSURANCE COVERAGE: BY CHECKING THE BOX TO THE LEFT, YOU ACKNOWLEDGE THAT YOU MEET THE AMERICAN RED
             CROSS' MINIMUM AUTOMOBILE INSURANCE REQUIREMENTS OF $ 50,000/ $ 100,000 BODILY INJURY AND $ 10,000 PROPERTY DAMAGES.
             THIS BOX MUST BE CHECKED IF THE EMPLOYEE IS TO RECEIVE POV MILEAGE EXPENSE REIMBURSEMENT FROM THE CHAPTER.




SIGNATURE:                                                                                                 DATE:



SUPERVISOR APPROVAL:                                                                                       DATE:



SUPERVISOR APPROVAL:                                                                                       DATE:

				
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