GATESOL-Travel Expense Statement -- SAMPLE

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GATESOL-Travel Expense Statement -- SAMPLE Powered By Docstoc
					                                                                                                                      GATESOL
                                                                                                          TRAVEL EXPENSE STATEMENT -- SAMPLE

Name        Jane Smith                                                            Destination                             New York, NY                              Purpose of Travel                                        TESOL Convention

Residence 1234 1st Ave.                         Atlanta                           GA              00000
            Street                                       City                             State           Zip Code


                            TRANSPORTATION                    mileage rate 0.51                                                                                     SUBSISTENCE                                                                    OTHER EXPENSE
                                                                                                                                                                                                                                       Identify Expenses
                                                                                                                                                                                     Total Meals       Lodging
                                           Odometer                       Amount             Other                                                                                                                                       (attach receipts)
                Time                                                                                          Total         Breakfast        Lunch         Dinner      Incidentals        &             (attach           Total                                      Amount of Other
                                            Reading                       Common           Transport
                                                                                                                                                                                     Incidentals       receipt)                                                         Expense
                                                           Mileage         Carrier
   Date       Departure     From:         Beginning:                                          (attach         Trans.                                                                                                   Subsi-
               Arrrival     To:                                               (attach         receipt)                                                                                                                 stence
                                          Ending:
                                                                              receipt)
                                                             Do not                                          Do not        No receipts necessary - fill in the              Do not                                      Do not
                 Only                         Only        complete -                                      complete - allowable per diem amounts for any meals            complete -                                  complete -
              complete if                 complete if     will automa- Divide total         Ex.: Bus,     will automa- that are paid out of pocket. Contact the $5.00 on will automa-                 Divide total   will automa-    Example: Parking,
               using air                  traveling by        tically  ticket amount       taxi, hotel        tically  Treasurer to confirm allowable per diem FULL DAYS     tically                  bill by # of       tically  Registration, tolls, baggage
                travel                        car          calculate        by 2             shuttle       calculate                   amounts.                  ONLY     calculate                     nights.       calculate               fees               Enter Expense Amount
               1:15 PM      Atlanta to
 01/01/10
               2:37 PM      New York
                                                          $          -    $      103.44   $       20.00   $ 123.44                                     $      36.00                  $      36.00     $    156.07    $ 192.07         Conference Registration    $              350.00
                                                                                                                                                                                                                                      Baggage Fees ($25 each
                                                          $          -                                    $           -     $    12.00                 $      36.00    $      5.00   $      48.00     $    156.07    $ 204.07                 way)
                                                                                                                                                                                                                                                                 $               50.00

                                                          $          -                                    $           -     $    12.00   $     18.00   $      36.00    $      5.00   $      71.00     $    156.07    $ 227.07                                    $                     -

                                                          $          -                                    $           -     $    12.00   $     18.00   $      36.00    $      5.00   $      71.00     $    156.07    $ 227.07                                    $                     -
               4:17 PM      New York to
  1-5-`0
               6:02 PM      Atlanta
                                                          $          -    $      103.44                   $ 103.44          $    12.00   $     18.00                                 $      30.00                    $ 30.00                                     $                     -

                                                          $          -                                    $           -                                                               $           -                   $           -                              $                     -

                                                          $          -                                    $           -                                                               $           -                   $           -                              $                     -
                                                                                                                                    TOTAL                                                                                                    TOTAL
                                                                         TOTAL TRANS.
                                                                         $
                            TOTAL MILES     $                      -                      $                226.88               SUBSISTENCE    $        $                                                              880.28               OTHER $
                                                                                                                                                                                                                                                                 $             400.00
  Please attach original receipts for transportation, lodging & other                          TOTAL REIMBURSEMENT $                     $             1,507.16
  expenses. DO NOT attach meal receipts. All meals will be                                                                                                                                Check
                                                                                                                                                                                                                     Check Date
  reimbursed according to current per diem rates established by the                            CASH ADVANCE AMOUNT $                                                                     Number
  State of Georgia.
                                                                                                           TOTAL DUE            $        $             1,507.16
  Signature                                     Date
                                                                                                  TREASURER’S APPROVAL __________________________________ DATE _________________

				
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