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					OSF FORM 19                                                                                                    Prepared By
STATE OF                                                                                                       Phone Number
OKLAHOMA
TRAVEL VOUCHER
IS CAR GOV OWNED ?                                                                                                                                   CLAIM OF:
Y     N
Tag #
IS CLAIMANT A                                                                                                        NAME:
STATE OFFICIAL                                                                                                 EMPLID/ SSN:
OR EMPLOYEE ?
Y      N                                                                                                         Total Amount
VOLUNTEER ?                                                                                                        Claimed                                  $0.00
Y      N
STUDENT ?                                                                                                                                        ASSIGNMENT
Y      N                                                                                                                                    I hereby assign this claim to
CITY, STATE OF OFFICIAL
EMPLOYMENT SITE
                                                                                                               and authorize the St. Treasurer to issue warrant in payment to said assignee
 Nature of Official Business:

                                                                                                               Date:                                 Claimant Signature

Show point travel status began, each point visited and               YEAR           MILEAGE          TRAVEL STATUS          NUMBER                  PER DIEM          LODGING           TOTAL
the point travel status ended. (Vicinity only travel should                         CLAIMED                HOUR                  OF                                                    PER DIEM
show general geographics area, e.g. Tulsa Vicinity).               Mo     Day     Map     Vicinity   Entered     Ended     Days    Hrs.       Rate       Amount        Amount          LODGING
                                                                                                                                                                                         0.00
                                                                                                                                                                                         0.00
                                                                                                                                                                                         0.00
                                                                                                                                                                                         0.00
                                                                                                                                                                                         0.00
                                                                                                                                                                                         0.00
                                                                                                                                                                                         0.00
                                                                                                                                                                                         0.00
                                                                                                                                                                                         0.00
                                                                                                           TOTALS            0        0                    0.00             0.00        $0.00
                                                                                    0         0        0       TOTAL MILES @              55.500%                                       $0.00
                         Trip Optimizer Used for Mileage Comparison                       Exempt from Trip Optimizer        X     (Place 'X' in appropriate box per Title 74, § 85.45I)
                                                 * Must be lowest amount from the Trip Optimizer results. (Multiple trips total if necessary)
                            >>MUST ATTACH COPY OF THE TRIP OPTIMIZER RESULTS TO THE VOUCHER. (ALSO, UNAVAILABILITY NOTICE OF RENTAL CAR) <<
                                                >>For accurate results the optimizer calculation must be performed prior to the trip<<
PUBLIC TRANSPORTATION
Was public transportation purchased directly by the University         Y         N
If the answer is no to the above or if additional costs were incurred, list type of public transportation (airplane, etc.) and amount claimed.
                                                                                                                                  TOTAL PUBLIC TRANSPORTATION
Itemized Local Transportation:                                                            Itemized Miscellaneous Costs:
Taxi:                                                                                     Registration:                                     (Number of Meals:                      )
Shuttle:                                                                                  Telephone:
Rental Car:                                                                               Parking:                                          Tolls:
Other Local Transp:                                                                       Other:
Rental Car Justification:                                                                                                        Total Miscellaneous Costs                                 $0.00
                                                                                                                                 Total Local Transportation                                $0.00
CLAIM APPROVAL:
I hereby approve this claim for payment and certify to the best of my knowledge that it complies                                 TOTAL AMOUNT CLAIMED                                      $0.00
with the travel policies of the University of Oklahoma. I also certify that I am in a position of                            Maximum amount approved
greater institutional authority and am completely independent from the individual receiving the                              Department Number
travel reimbursement.                                                                                          Reimbursement should be mailed to:

     DATE         CLAIM APPROVAL SIGNATURE



I,                                                               by signing here do under penalty of
perjury, declare that the information contained in this document and any attachments are true and                 I hereby approve this claim for payment and certify it complies with
correct to the best of my knowledge and belief. I also certify that no frequent travel miles earned               the travel laws of this State, State Travel Reimbursement Act, or
from any official state transportation have been used for personal transportation purposes.



     DATE         CLAIMANT SIGNATURE


                                                                                                                                  AGENCY'S APPROVING OFFICER

				
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