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Rockingham County
Online Use Instructions
Input boxes
Use this form for all travel on or after July 1, 2011
The Personal Mileage Form should be used if you are requesting mileage reimbursement only.
Use the Travel Reimbursement Form for reimbursement that includes mileage and other travel
expenditures.
Use Tab to move between Input Boxes.
Place Cursor over the input box to read instructions for the box.
Request for Payment Form is attached for Department to download and use, as needed. If you
print this form, it should be on Green Paper. Finance Department will accept White Paper if
green is not available.
To verify which County a City or a Town is Located, see the Sales Tax Guide that was given
out at the Procurement Card Training Session. Or visit the N. C. Department of Revenue at the
following address:
http://www.dor.state.nc.us/downloads/Gen562.pdf
To verify the Occupancy Tax Rate and the Meals Tax Rate visit N. C. Department of
Revenue at the following address.
http://www.dor.state.nc.us/taxes/sales/levydates_10-10.pdf
The State updates these list as needed.
Update Excel 07/01/11
8/7/2012 0c97b0be-71f2-43f1-aa95-5f77d42d4468.xls Instuctions
ROCKINGHAM COUNTY
TRAVEL ADVANCE REQUEST
Date: BUDGET ACCOUNT CODE:
Name: BUDGET ACCOUNT CODE:
Department: Employee/Vendor Number:
Destination: Travel Date (s):
From: To:
Purpose of Travel/Meeting: (ATTACH COPIES OF PERTINENT BACKUP INFORMATION)
Estimated Expenses: (USE WORKSHEET INCLUDED IN THIS EXCEL WORKBOOK)
ADVANCE EMPLOYEE
Mode of Transportation:
Transportation: County Vehicle
Registration: Private Vehicle
Meals: Air Carrier
Lodging: Other
Overnight
Other: Accommodations
Hotel/
Motel:
TOTAL TRAVEL
EMPLOYEE ADVANCE REQUESTED Rate/Night/Person
ATTACH SEPARATE PAYMENT REQUESTS FOR REGISTRATION,
LODGING, TRANSPORTATION, ETC. THAT ARE TO BE PAID
DIRECTLY TO THE VENDOR IN ADVANCE
Comments:
Employee Signature County Manager Approval
(For Out-of-State Requests Only)
Authorizing Party
If other than Department Head Finance Department Approval
Department Head
If required
All Travel Forms must be complete in Excel, Typed or printed legibly.
Update Excel 07/01/11
8/7/2012 0c97b0be-71f2-43f1-aa95-5f77d42d4468.xls Advance Request
ROCKINGHAM COUNTY
TRAVEL ADVANCE WORKSHEET
Name:
Date:
Dates Weekly
EXPENSES Totals
Registration Fees
Lodging
Breakfast ($7)
Lunch ($9)
Dinner ($16)
Gas-County Car Car #
Mileage- (Personal Car Only): Mileage
Estimated # of miles @
55.5 Cents 0.0
Public Transportation
Other (Specify below) 5
ESTIMATE TOTALS
Lodging Information
Hotel/Motel Name Phone #
Nightly Rate Due to Tax Reimbursement Regulations, the
Sales Taxes breakdown between Sales Tax and Occupancy
Occupancy Taxes Tax is required for all Hotels /Motels in NC.
TOTAL PER NIGHT $ - All Taxes for out-of-state hotels/motels can be
included in the Nightly Rates.
Comment/Remarks
NOTES:
l Travel Reconciliation must be submitted to the Finance office on or before
the 25th of the month.
l
All Travel Forms must be complete in Excel, Typed or printed legibly.
Update Excel 07/01/11
8/7/2012 0c97b0be-71f2-43f1-aa95-5f77d42d4468.xls Advance Worksheeet
ROCKINGHAM COUNTY
TRAVEL REIMBURSEMENT
NAME: DATE:
DEPARTMENT: BUDGET ACCOUNT CODE:
DESTINATION: BUDGET ACCOUNT CODE:
BUDGET ACCOUNT CODE:
BUDGET ACCOUNT CODE:
Employee/Vendor Number:
DATES
ALL EXPENSES: TOTALS
REGISTRATION FEES
LODGING
BREAKFAST ($7)
LUNCH ($9)
DINNER ($16)
Number
Gas-County Car
PERSONAL CAR
MILEAGE FROM
MILEAGE LOG
PUBLIC
TRANSPORTATION
OTHER (ATTACH
RECEIPT OR
EXPLANATION)
TOTALS
*Attach Mileage Log if Used.
PLEASE ATTACH RECEIPTS AS REQUIRED
GRAND TOTAL EXPENSES I certify that this is a true and accurate statement of
expenses incurred in the conduct of official Rockingham
LESS (all prepaid and advances) : County business.
Advance to Employee
__________________________________________
EMPLOYEE SIGNATURE
Paid by County Procurement Card if
included
__________________________________________
APPROVED BY
__________________________________________
TOTAL FUNDS ADVANCED DEPARTMENT HEAD APPROVAL
If required
Amount Due Employee
__________________________________________
FINANCE DEPARTMENT APPROVAL
All Travel Forms must be complete in Excel, Typed or printed legibly.
Update Excel 07/01/11
8/7/2012 0c97b0be-71f2-43f1-aa95-5f77d42d4468.xls Travel Reimbursement
ROCKINGHAM COUNTY ROCKINGHAM COUNTY
TRAVEL REIMBURSEMENT
MILEAGE LOG
NAME: DEPARTMENT
Travel ODOMETER
DATE From To BEGIN END # of MILES
TOTAL MILES
Times Mileage Rate in
Dollars $ 0.555
Carry to Travel
Reimbursement Form
All Travel Forms must be complete in Excel, Typed or printed legibly.
Update Excel 07/01/11
8/7/2012 0c97b0be-71f2-43f1-aa95-5f77d42d4468.xls Mileage Log
ROCKINGHAM COUNTY ROCKINGHAM COUNTY
PERSONAL VEHICLE MILEAGE
MILEAGE ONLY
NAME: DEPARTMENT:
Travel ODOMETER
DATE From To BEGIN END # of MILES
TOTAL MILES
Times Mileage Rate
Object Codes to Charge: Amount in Dollars $ 0.555
Less Advances
The Personal Mileage Form should be used if you are requesting
mileage reimbursement only. Use the Travel Reimbursement
Form for reimbursement that includes mileage and other travel
expenditures.
I certify that this is a true and accurate statement of expense
incurred in the conduct of official Rockingham County Business
For Department Use Only
EMPLOYEE SIGNATURE
APPROVED BY
DEPARTMENT HEAD APPROVAL
If required
FINANCE DEPARTMENT APPROVAL
All Travel Forms must be complete in Excel, Typed or printed legibly.
Update Excel 07/01/11
8/7/2012 0c97b0be-71f2-43f1-aa95-5f77d42d4468.xls Personal Mileage Form
Rockingham County
Request for Payment Form
Date of
Finance Use Only Request
Vendor #
Date Total Check Amount
Requested $ -
Department
From:
PAY TO:
REMITTANCE
ADDRESS
Reason for Payment:
(Reason only needed if no Invoice attached)
Line Fund Department Activity Object Description Amount
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
Special Instructions:
Process the Attached item('s) and mail check to payee.
Enclose attached documents with check
Return check to department for Disposition. Reason:
Notify Department when ready for Pickup. Reason:
Approved for Payment Approved for Payment
Department Official Finance Department
All Travel Forms must be complete in Excel, Typed or printed legibly.
8/7/2012 0c97b0be-71f2-43f1-aa95-5f77d42d4468.xls Request for Payment
Update Excel 07/01/11
8/7/2012 0c97b0be-71f2-43f1-aa95-5f77d42d4468.xls Request for Payment
