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					Form DFC6/Rev 7/96                                                                                                                                                      Original for Comptroller

                                                                         STATE OF ALABAMA
                                                                     Statement of Official In-State Travel

                   Youth Services                                          _____________
                  Department/Agency                                           Code Number                                Division                                           Funds
                                                                                                              Name:
                    APPROVED                                                                                  Address:
                                                                   Department Head
                                                                                                              SSN:
                                                                                                              Day Time Phone #:
Official Station or Base                                                                                      Above Space for Name, Address & SS# of Traveler

   Month                                POINTS OF TRAVEL                                          Private       Hour of                              Hour of                   Amount Per
    And                        From                                      To                        Car    Departure from Base                     Return to Base                 Diem
   Date                     City/County                             City/County                   Miles     AM          PM                        AM         PM                 Claimed




 TOTAL NUMBER OF MILES TRAVELED                                                                       0        TOTAL PER DIEM CLAIMED                                                $0.00
                                                                                                               TOTAL MILEAGE                                                         $0.00
Detail miscellaneous expense and furnish receipts when required. This space for departmental approval, etc.    MISCELANEOUS EXPENSES*
Use extra sheets when necessary.
                                                                                                                                                                                     $0.00
                                                                                                               TOTAL THIS EXPENSE ACCOUNT                                            $0.00
                                             Supervisor
                                                                                                              I HEREBY CERTIFY that the travel and expense indicated hereon was
                                          Administrator                                                       accomplished in the performance of official duties pursuant to travel granted me.


                                                                                                                                                             Signature of Traveler


                                                                                                              Sworn to and subscribed before me this the _______________


                                                                                                              Day of _________________, 2009


*Price/mile     0.55
                                                                                                                                                Notarty Public

				
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