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EXPENSE REIMBURSEMENT FORM

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EXPENSE REIMBURSEMENT FORM Powered By Docstoc
					                                       UNIVERSITY OF OKLAHOMA
                         EMPLOYEE NON-ACCOUNTABLE PLAN EXPENSE REIMBURSEMENT


           EMPLOYEE NAME:
           EMPLID:
           PREPARED BY:
           PHONE NUMBER:
           EXPENSE DATE:
                             FROM:                                        TO:
           DEPARTMENT #:           _____________________           ACCOUNT #: _______________

PAYMENTS REPORTABLE AS INCOME
        Type of Expense                                                                          Total
                     1
                     2
                     3
                     4
                     5
                     6
                     7
                     8
                     9
                   10
           Total Expense Reimbursements Reportable as Income                                               -

           Describe how this expense benefits the University:




REASON FOR TAXABILITY: (check one)
         Over 120 days: all reimbursements of expenses more than 120 days after the date of the event
         (for travel, the date of return, for non-travel, the date of purchase)
         Other:

CERTIFICATION:
          I understand that all reimbursements listed on this form are considered non-accountable expenses
          and will be treated as taxable income, therefore, these amounts will be added to my W-2 at the end
          of the calendar year.

           EMPLOYEE SIGNATURE:                                                    DATE:


SPONSOR'S APPROVAL: ___________________________________________
SUPERVISOR'S APPROVAL: _________________________________________
 (Must be of higher institutional authority than employee being reimbursed.)

				
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