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Receipt Summary Worksheet DISB

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Receipt Summary Worksheet DISB Powered By Docstoc
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DISB - 4D
                                           Receipt Summary Worksheet
Traveler                                                                                              Document No.:
 Item       Date                         Explanation                         No Receipt Amt            Receipt Amt             Acct Code              Subcode

   1.

   2.

   3.

   4.

   5.

   6.

   7.

   8.

   9.

  10.

  11.

  12.

  13.

  14.

  15.

  16.

  17.

  18.

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  20.

  21.
                                                               TOTAL*               0.00                    0.00             GRAND TOTAL               0.00
* I certify that travel expenses totalling $_____________ were incurred in the conduct of official business. Receipt was not available for expenses
                                                 0.00
  totaling $____________ and do not include gratuity. All other receipts are attached.
                    0.00
  All claims shown above are the amounts I actually paid and I have not and will not seek reimbursement from any other source.

____________________________________________________________________________________
Signature of Traveler                                                   Date

				
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