Employee_Expense_Statement_09-10_1_

					                                                                                  PIERCE COUNTY BOARD OF EDUCATION
                                                                                                Employee Expense Statement


Name:                                                          Employee ID/Clock #                                                 School:                                        Date:

Mailing Address:                                                                                                                                                         Auto License#
                      Street or P.O. Box                                       City                                     State                     Zip



                                   TRANSPORTATION                                                                                     SUBSISTENCE                                                      OTHER
                                                                                                                 Details of Subsistence (attach lodging receipts)                                                    Other
                                                                        Purpose of Travel
                                                Odometer       No. of    (may be optional for        Total                                        Total                                        Identify Other      Expenses
   Date      Time            From/To            Begin/End      Miles           some)                Trans.    B/fast    Lunch      Dinner         Meals       Lodging     Total Subsistence      Expenses           Amount

                                                                   -                            $       -                                     $         -                 $             -

                                                                   -                            $       -                                     $         -                 $             -

                                                                   -                            $       -                                     $         -                 $             -

                                                                   -                            $       -                                     $         -                 $             -

                                                                   -                            $       -                                     $         -                 $             -

                                                                   -                            $       -                                     $         -                 $             -

                                                                                                             TOTAL SUBSISTENCE                                            $             -     Total Other              0

                                                  TOTAL            -         TOTAL              $       -
                                                                                                                                GRAND TOTAL - AMOUNT TO BE REIMBURSED                         $             -
                                                  MILES                      TRANS.
                                                              X 0.51

Hospital Home Bound Student Name:                                                                     FUNDING SOURCE                                        Number of pages in report and totals for each page:
                                                                                         Place a check beside the appropriate category
                                                                        Regular Travel                             Title VI-B IDEA
                                                                        Professional Learning                      Hospital Home Bound
I do solemnly swear the information furnished above is true             Title I-A (402)                            Vocational (QBE)
and correct to the best of my knowledge, and I have                     Title I-C (Migrant)                        CTAE (YAP)
incurred the described expenses and the state use                       TII-A                                      Perkins Program Imp.
mileage in the performance of my official duties.                       TIII-A (LEP)                               Perkins Prof. Dev.
                                                                        Title VI-B Rural/Low                       CTAE Industry Cert.
                                                                        Pre-K                                      CTAE Perkins ECP
                                                                        Other



Name of Conference/Location



Employee's Signature                        Date                       Principal's Signature                        Date                     Approved By                                             Date
             Travel forms should be submitted within seven (7) days of a conference. All travel must be filed monthly.                                                                                          (Revised 1/2010)

				
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