Reimbursment Form - State Bar of Texas.xls
Document Sample
STATE BAR OF TEXAS
Request for Reimbursement of Expenses
Date of Request
PURPOSE OF TRAVEL: Reimbursement Requests must be forwarded to the
appropriate authorizing department for processing.
From To
PLEASE SEE BELOW FOR A LIST OF APPLICABLE
Date(s) of meeting - DEPARTMENTS
Date(s) of travel -
Location of meeting Please complete areas highlighted in GREEN
STATE BAR APPROVAL
MAKE CHECK PAYABLE TO:
Date Approved for Payment:_______________________________, 20______
(Name of Individual, Firm , or Company)
Barcard # (if appicable) __________________________________________________________________
Name (Officer, Committee Chair, Executive, Dept. Head, Other)
Street Address
__________________________________________________________________
Finance Department
City, State and Zip
Telephone Number
MEETINGS AND TRAVEL EXPENSE
Transportation Items and Descriptions AMOUNT
Airfare $ - $ -
Speaker Airfare (TxBarCLE use only) $ - $ -
Car Rental & Fuel $ - $ -
Taxi / Limo Service $ - $ -
(0.51 Before Jul 1, 2011
Parking & Tolls $ - $ -
Auto Mileage
)
@ $ 0.555 ===========> $ -
Other $ - (Enter Description Here) $ -
Travel Subtotal $ -
Lodging and Meals Items and Descriptions Daily Total
Date Hotel Meals Non-Dues
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
Lodging & Meals Subtotal $ - $ - $ - $ -
Expenses Not Related Travel, Lodging, or Meals
Description $ - $ -
***** For State Bar Use Only ***** $ - <======> $ -
FUND-DEPT-ACCT LOCATION MDA TOTAL Total Reimbursment Requested
--50200- - $ -
--50205- - $ -
--50210- - $ -
CERTIFICATION OF CLAIMANT
--50215- - $ -
--50220- - $ - The above described expenses were incurred by me
--50225- - $ - for the purpose stated. I have attached receipts for
applicable expenditures (airlines, hotels, etc.), except
--50230- - $ - in cases where receipt has been lost. I certify that this
request is true, correct, and unpaid.
--50252- - $ -
--50285- - $ -
- $ -
___________________________________________
- $ - Signature of Claimant Date
- $ -
Enter Fund Code Enter Location
Enter Dept Code Enter MDA
STATE BAR OF TEXAS
Request for Reimbursement of Expenses
State Bar of Texas
Reimbursements for approved Board of Directors
Officers & Directors Department
related business, meetings and functions
P.O. Box 12487
Board of Directors
Austin, Texas 78711-2487
Attn: Reimbursement Request
State Bar of Texas
Reimbursements for approved State Bar committee
Committees Department
P.O. Box 12487 business, meetings and functions.
Committees
Austin, Texas 78711-2487
Attn: Reimbursement Request
State Bar of Texas Reimbursements for qualified/approved State Bar
Sections Department Section, business, meetings and functions.
Sections P.O. Box 12487
Austin, Texas 78711-2487
Attn: Reimbursement Request
State Bar of Texas Reimbursements for approved Commission for
Chief Disciplinary Counsel Lawyer Discipline and Chief Discplinary Counsel
Chief Disciplinary P.O. Box 12487 Office business and meetings.
Counsel Austin, Texas 78711-2487
Attn: Reimbursement Request
State Bar of Texas
TYLA Department Reimbursements for approved TYLA business,
P.O. Box 12487 meetings and functions.
TX Young Lawyers
Austin, Texas 78711-2487
Attn: Reimbursement Request
State Bar of Texas
TexasBarCLE Department Reimbursements related to TexasBarCLE program
P.O. Box 12487 business, speakers, etc.
TexasBarCLE
Austin, Texas 78711-2487
Attn: Reimbursement Request
State Bar of Texas
Accounting Department Reimbursements for approved State Bar employe
P.O. Box 12487 business expenses, meetings, travel, etc.
SBOT Employees
Austin, Texas 78711-2487
Attn: Reimbursement Request
State Bar of Texas
Texas Bar Books Reimbursements for approved Texas Bar Books
P.O. Box 12487 business expenses, meetings, travel, etc.
Texas Bar Books
Austin, Texas 78711-2487
Attn: Reimbursements
STATE BAR OF TEXAS
Request for Reimbursement of Expenses
Reimbursement forms should be first
forwarded to your appropriate District
Subcommittee Chair for approval and
signature,. Then send the form to: UPLC, P.O.
Box 12487, Austin, TX 78711-2487 or Reimbursements for approved UPL Committee
Unauthorized Practice of
zara.munoz@texasbar.com. The form will then business expenses, meetings, travel, etc.
Law Committee
be reviewed for approval by the Chairman of
the UPLC.
Texas Board of Legal Odessa Bradshaw
Specialization TBLS, Associate Executive Director Reimbursements for approved TBLS business expenses ,
505 E. Huntland Dr., Ste. 400, LB 28 meetings, travel, etc.
Austin, TX 78752
Law Related Education Reimbursements for approved Law Related
Law Related Education P.O. Box 12487 Education business expenses , meetings, travel,
Department Austin, TX 78711-2487 etc.
Attn: Reimbursement Request
College of the State Bar of Texas Reimbursements for approved College of the
P.O. Box 12487 State Bar business expenses, meetings,
Austin, TX 78711-2487 travel, etc.
College of the State Bar Attention: Merianne Gaston
Minority Affairs Minority Affairs Reimbursements for approved Minority Affairs business
State Bar of Texas expenses, meetings, travel, etc.
P.O. Box 12487
Austin, TX 78711-2487
STATE BAR OF TEXAS
Request for Reimbursement of Expenses
), except
y that this
STATE BAR OF TEXAS
Request for Reimbursement of Expenses
STATE BAR OF TEXAS
Request for Reimbursement of Expenses
8/1/2012
Date of Request
PURPOSE OF TRAVEL:
Vendor Meeting Reimbursement Requests must be forwarded to
the appropriate authorizing department for
From To processing.
Date(s) of meeting 4/30/2009 - 5/12/2009
Date(s) of travel 4/30/2009 - 5/12/2009 PLEASE SEE BELOW FOR A LIST OF
Location of meeting Dallas, Texas APPLICABLE DEPARTMENTS
STATE BAR APPROVAL
MAKE CHECK PAYABLE TO:
Date Approved for Payment:_______________________________, 20______
(Name of Individual, Firm , or Company)
Barcard # (if appicable) 01234567 __________________________________________________________________
Name John Q. Public (Officer, Committee Chair, Executive, Dept. Head, Other)
Street Address 1414 Colorado Street __________________________________________________________________
STE 666 Finance Department
City, State and Zip Austin, Texas 78701
Telephone Number
MEETINGS AND TRAVEL EXPENSE
Transportation Items and Descriptions AMOUNT
Airfare $ 1,200.00 $ 1,200.00
Speaker Airfare (TxBarCLE use only) $ 100.00 $ 100.00
Car Rental & Fuel $ 300.00 $ 300.00
Taxi / Limo Service $ 8.00 $ 8.00
(0.585 Before Jan 1, 2009
Parking & Tolls $ 50.00 $ 50.00
Auto Mileage 30 @ $
) 0.550 ===========> $ 16.50
Other $ 25.00 (Enter Description Here) $ 25.00
Travel Subtotal $ 1,699.50
Lodging and Meals Items and Descriptions Daily Total
Date Hotel Meals Non-Dues
4/30/2009 $ 100.00 $ 50.00 $ 25.00
5/1/2009 $ 100.00 $ 50.00 $ -
5/2/2009 $ 100.00 $ 50.00 $ 25.00
5/3/2009 $ 100.00 $ 50.00 $ -
5/4/2009 $ 100.00 $ 50.00 $ 25.00
5/5/2009 $ - $ 50.00 $ -
Lodging & Meals Subtotal $ 500.00 $ 300.00 $ 75.00 $ 875.00
Expenses Not Related Travel, Lodging, or Meals
Description $ - $ -
***** For State Bar Use Only ***** $ 2,574.50 <======> $ 2,574.50
FUND-DEPT-ACCT LOCATION MDA TOTAL Total Reimbursment Requested
1-2222-50200- - $ 1,200.00
1-2222-50205- - $ 500.00
1-2222-50210- - $ 300.00
CERTIFICATION OF CLAIMANT
1-2222-50215- - $ 8.00
1-2222-50220- - $ 300.00 The above described expenses were incurred by me for the
1-2222-50225- - $ 16.50 purpose stated. I have attached receipts for applicable
expenditures (airlines, hotels, etc.), except in cases where
1-2222-50230- - $ 50.00 receipt has been lost. I certify that this request is true,
correct, and unpaid.
1-2222-50252- - $ 75.00
1-2222-50285- - $ 100.00
01-2222-66666 - $ 25.00
_______________________________ _______________
- $ - Signature of Claimant Date
- $ -
- $ -
- $ -
STATE BAR OF TEXAS
Request for Reimbursement of Expenses
Enter Fund Code 01 Enter Location
Enter Dept Code 2222 Enter MDA
Board of Directors State Bar of Texas
Reimbursements for approved Board of Directors
Officers & Directors Department
related business, meetings and functions
P.O. Box 12487
Austin, Texas 78711-2487
Attn: Reimbursement Request
Committees State Bar of Texas
Committees Department Reimbursements for approved State Bar
P.O. Box 12487 committee business, meetings and functions.
Austin, Texas 78711-2487
Attn: Reimbursement Request
Sections State Bar of Texas
Sections Department Reimbursements for qualified/approved State Bar
P.O. Box 12487 Section, business, meetings and functions.
Austin, Texas 78711-2487
Attn: Reimbursement Request
Chief Discpl. Cnsl. State Bar of Texas
Chief Disciplinary Counsel Reimbursements for approved Commission for
Lawyer Discipline and Chief Discplinary Counsel
P.O. Box 12487
Office business and meetings.
Austin, Texas 78711-2487
Attn: Reimbursement Request
TX Young Lawyers State Bar of Texas
TYLA Department Reimbursements for approved TYLA business,
P.O. Box 12487 meetings and functions.
Austin, Texas 78711-2487
Attn: Reimbursement Request
TexasBarCLE State Bar of Texas
TexasBarCLE Department Reimbursements related to TexasBarCLE
P.O. Box 12487 program business, speakers, etc.
Austin, Texas 78711-2487
Attn: Reimbursement Request
SBOT Employees State Bar of Texas
Accounting Department Reimbursements for approved State Bar employe
P.O. Box 12487 business expenses, meetings, travel, etc.
Austin, Texas 78711-2487
Attn: Reimbursement Request
WHERE TO SEND
YOUR
REIMBURSEMENT
REQUEST
STATE BAR OF TEXAS
Request for Reimbursement of Expenses
1/1/2009
e for the
