Get documents about "4 TRR Domestic Limits 0711 44 cents
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- posted:
- 8/8/2012
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- 8
Document Sample
University of Southern Indiana
Travel Reimbursement Request
Pre-set Funding Limits
I certify that the following account is just and correct, that the amoun
due, after allowing all just credits, and that no part of the same has b
Name of Claimant
Signature of Claimant D
Street Address
I certify I have examined this claim, that travel was authorized from a
and for period and at the rate claimed, that same is correct, except a
City/State/Zip
pertaining to University business
Financial Manager Date
Mode of Transportation Used:
Departure Date: Departure Time:
Return Date: Return Time:
Date Departure City Arrival City Lodging Per Diem Mileage Other
00-Jan-00 USI/Evansville, IN * $0.00
$0.00
$0.00
$0.00
Sub Total $0.00 $0.00 $0.00 $0.00
Meals Provided $0.00 $0.00
In-State Out-of-State
USI Paid Expenses $0.00 Sub Total of Expens
Less Meals Provided In-Sta
FOAP(s) and Amount(s) Approved Less Meals Provided Out-of-Sta
FUND ORGN ACCT AMOUNT Traveler's Cla
Approved Fundin
Less USI Paid Expens
Available Fun
FOAP(s) and Amount(s) to be Charged Pay The Lesser of A or
FUND ORGN ACCT AMOUNT Add Gas Expense for Univ. Ve
Total Amount Du
The amount(s) entered above equals the Total Amount Due TRUE
Travel voucher prepared by: USI phone number:
FOR BUSINESS OFFICE USE ONLY I
E
Encumberance Number Banner Invoice
1099 ___________
0
Vendor Number Check Due Date
Separate Check Required
Entered By Verified By
Hold Check
Date Date
Attachment
nt is just and correct, that the amount claimed is legally
s, and that no part of the same has been paid.
Date
aim, that travel was authorized from and to points claimed
aimed, that same is correct, except as noted and is all
s
Date
Totals
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Sub Total of Expenses $0.00
Less Meals Provided In-State $0.00
s Meals Provided Out-of-State $0.00
Traveler's Claim $0.00
Approved Funding $0.00
Less USI Paid Expenses $0.00
Available Funds $0.00
Pay The Lesser of A or B $0.00
d Gas Expense for Univ. Veh. $0.00 $0.00
Total Amount Due $0.00 $0.00
Banner Invoice
Check Due Date
Verified By
Date
Documentation and Receipt Checklist
N/A Enclosed Documentation
Copy of travel authorization. If trip is covered under job description, then provide purpose.
University vehicle chargeback(s)
Lodging receipt w/ calls marked "personal" or "business" or host name, address & phone #
Conference program or meeting agenda showing location, dates, events, & meals.
Conf. Reg. form showing what's included in fee and Conf. fee receipt (if pd by traveler).
Shuttle, taxi or other ground transportation receipts.
Airline passenger receipt or 'ticketless' confirmation. If consolidator, copy of cc chrg.
Flight itinerary and boarding passes.
Rental car agreement and receipt. (Expense must be approved prior to travel).
NOTES:
Receipts must be original and have a zero balance or cc receipt copy attached (black out #).
Receipts must be stapled together and attached.
Document any reason for extended travel before or after conference/meeting dates.
Provide third-party documentation of single occupancy rate when room is shared and full amount is claimed.
If lodging was at 'no-cost', then provide the name, address, and telephone number of the host.
Per Diem Rates and Meals Provided
Per Diem Rates and Policy
In-State Meals Provided Quantity Type Date(s) Rate Total
Breakfast $6.50 ea $0.00
Lunch $6.50 ea $0.00
Dinner $13.00 ea $0.00
Total $0.00
Out-of-State Meals Provided Quantity Type Date(s) Rate Total
Breakfast $8.00 ea $0.00
Lunch $8.00 ea $0.00
Dinner $16.00 ea $0.00
Total $0.00
USI Paid Expenses
For multiple FOAP's, list each FOAP charged for each expense or portion of expense.
Do not include trip expenses listed on page 1. List only those expenses paid/reimbursed by USI
Expense Type $ Paid FUND ORGN ACCT $ Paid
Total $0.00 $0.00
Gas Expense for University Vehicle
Mileage for Use of Personally Owned Vehicle
Mileage Chart and Rates
Roundtrip Mileage Claim with Odometer Readings for One Trip Only
Beginning Ending 0 Total Miles
Roundtrip Mileage Claim Using Standard Mileage for One Trip Only
Standard mileage requested per USI Mileage Chart or Mapquest
If Mapquest is used, attach mileage print out
Mileage Log for Multiple Trips with Odometer Readings Odometer
Date List From and To and Business Purpose Start End
Totals
Mileage Log for Mutliple Trips Using Standard Mileage
or Mapquest. If Mapquest, then attach mileage print outs Standard Miles x 0.44
Date List From and To and Business Purpose Miles
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
0.00 $0.00
Gas Expense for University Vehicle
$0.00
Mileage for Use of Personally Owned Vehicle
$0.00 Claim
$0.00 Claim
Miles x 0.44
Miles
0.00 $0.00
0.00 $0.00
0.00 $0.00
0.00 $0.00
0.00 $0.00
0.00 $0.00
0.00 $0.00
0.00 $0.00
0.00 $0.00
0.00 $0.00
0.00 $0.00
0.00 $0.00
0.00 $0.00
0.00 $0.00
0.00 $0.00
0.00 $0.00
0.00 $0.00
0.00 $0.00
