2013_Travel_Expense_Form_Mileage by babbian

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									                                                                         GUNNISON COUNTY, COLORADO
                                                                               MILEAGE REIMBURSEMENT FORM
WARNING: THIS FORM MAY ONLY BE USED IF:
   A) A FLEET VEHICLE WAS NOT AVAILABLE AT THE TIIME OF YOUR TRAVEL, OR
   B) YOU HAVE BEEN PREAUTHORIZED TO USE A PERSONAL VEHICLE FOR LOCAL MILEAGE ONLY
DOCUMENTATION OF ONE OF THE ABOVE EXCEPTIONS, APPROVED BY THE PUBLIC WORKS DEPARTMENT, MUST BE ATTACHED TO THIS FORM

FUEL CHARGES PAID VIA THE GUNNISON COUNTY CREDIT CARD
Please attach a copy of each credit card receipt to this form and provide the original with account coding to the payables accountant.

DATE
AMOUNT
TOTAL                                                                                                                                                                                      $          -

MILEAGE EXPENSE DETAIL
I.R.S. Mileage Rate -                                                       2013                  56.50 cents per mile

                                                                                                                                             ODOMETER READING                TRIP
                   PURPOSE                              DATE                        FROM                                     TO              START      FINISH             MILEAGE          TOTAL
                                                                                                                                                                                  0.0
                                                                                                                                                                                  0.0
                                                                                                                                                                                  0.0
                                                                                                                                                                                  0.0
                                                                                                                                                                                  0.0
                                                                                                                                                                                  0.0
                                                                                                                                                                                  0.0
                                                                                                                                                                                  0.0
                                                                                                                                                                                  0.0
                                                                                                                                                                                  0.0
                                                                                                                                                                                  0.0
                                                                                                                                                                                  0.0
                                                                                                                                                                                  0.0
                                                                                                                                                                                  0.0

                                                                                                             TOTAL MILEAGE                                                          0.0 $              -
                                                                                                              LESS: FUEL CHARGES ON COUNTY CREDIT CARD                                                 -
                                                                                                             TOTAL MILEAGE REIMBURSEMENT                                                   $          -

CERTIFICATION - This form must be printed and manually signed prior to submittal to the Finance Department.

My signature certifies the amounts requested on this reimbursement form are accurate to the best of my knowledge and belief, and that payment has not been received by me from another source.


Employee also certifies and supervisor confirms that employee holds a valid driver's license and carries all insurance coverage required by law on the vehicle used for this travel, if applicable.


Employee Printed Name



Employee Signature                                                                                    Date                               Supervisor Signature                                             Date

								
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