Expense form District Deputy Canada 2012 Blank

							                                                                                                                                                                                   0.23


                                                         Expense Account of District Deputy-Canada

           (Please note rules on reverse side of this form)
                                                                                   Round Trip     Transportation at
  Date                      Travel                      Purpose/Council Number                                           *Room             *Meals   *Miscellaneous     Total
                                                                                    Mileage          .23 per km
                  From                   To




                                                                                  TOTALS

           *Receipts are required for all items                                  I hereby certify the foregoing to be a true and correct
                                                                                 statement of expenses incurred by me.



Approved by ………………………………………………………………..                                           Signature
                                                                                 ………………………………...……………...…………...……..…..………….....………
  Date     ………………………………………………………………..                                            Name                                        District #

                                                                                 ………………………………...……………...…………...……..…..………….....………
                                                                                 Street
                                                                                 ………………………………...……………...…………...……..…..………….....………
                                                                                 City             State/Province        Postal Zip Code




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