Turn in the Friday before the second Wednesday (B) Rev. 6-11
MONTHLY EXPENSE REPORT MAWSECO #938 MONTH:
Note: If for personnel development mileage, meals or other, please check “PD” column.
NAME: If home-based service, please put “HB” in other column.
DATE TO: PD MILEAGE MEALS OTHER REASON:
TOTAL REGULAR TOTAL
TOTAL REGULAR MILES @ 55.5 per mile $ MEALS, OTHER $ REGULAR EXPENSES $
TOTAL PERSONNEL TOTAL PERSONNEL DEVELOPMENT TOTAL PERSONNEL
DEVELOPMENT MILES @ 55.5 per mile $ MEALS, OTHER $ DEVELOPMENT EXPENSE $
TOTAL EXPENSE $
I declare under penalties of law that this claim is just and correct and that no part has been paid. Initial of Business Office Verification ______________
DATE: _____________________________________________ SIGNED: ________________________________________________
Claimant or Agent of the Claimant