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TA _PERM_ Travel Advance Permanent In-State

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                                                           STATE OF IOWA                                                    TA (PERM)
OFFICIAL DOMICILE
                                                          PERMANENT IN-STATE                                 DOCUMENT NUMBER
                                                      TRAVEL ADVANCE
DATE OF EMPLOYMENT                                                                                        APPROVAL (SUPERVISOR’S SIGNATURE)


NAME AND HOME ADDRESS                                                        ALTERNATE ADDRESS




Out-of-Pocket In-State Travel expenses for the preceding twelve                                         Summary Information
months have been:
  January                                July
 February                            August                                              Prior twelve month total                             0.00
    March                         September
      April                         October                                                      Average per month                            0.00
       May                        November
      June                        December                                                       Authorized amount                            0.00

                                                                  IMPORTANT
       Employees whose In-State Travel Expense has averaged between $100 and $150 per month for the preceding twelve
        months shall receive a Permanent Travel Allowance of $100.
       Employees whose In-State Travel Expense has averaged over $150 per month for the preceding twelve months shall
        receive a Permanent Travel Allowance of $150.

       I hereby give the DAS-SAE authority to deduct this Permanent In-State Travel Advance from my
        paycheck upon separation from State Employment or when I am no longer eligible due to a
        change in duties or job assignment.

       I also give the DAS-SAE and my employing Department the authority to review my monthly travel
        expense and determine if I still meet the requirements pertinent to receiving an In-State Travel
        Advance. Should I fail to meet these requirements, this Advance Travel Allowance shall be
        withdrawn and deducted from my next paycheck, following proper notification.

       Submit appropriate documents to Payroll
                                  CLAIMANT’S CERTIFICATION                                         DEPARTMENT CERTIFICATION
I CERTIFY I HAVE READ THE ABOVE AND AM AWARE OF THE RULES                            I CERTIFY THAT THE ABOVE EXPENSES WERE INCURRED
GOVERNING MY PERMANENT IN-STATE TRAVEL ADVANCE.                                      AND THE AMOUNTS ARE CORRECT AND SHOULD BE PAID
                                                                                     FROM THE FUNDS APPROPRIATED BY:
Employee Vendor #:                              DIRECT DEPOSIT?   WARRANT TO ALT     CODE OR CHAPTER SECTION(S)
                                                  Y      N        ADDR? Y   N
TITLE



CLAIMANT’S SIGNATURE                                                DATE




                                                                                   DOCUMENT TOTAL

TA (PERM)                                WARRANT #                                                                PAID DATE ___________
State of Iowa TA (PERM)                    Doc #      0                                                                           Dept. Name
Employee Vendor
                        0                                                                Name:         Last             First
#:
                                                                                                                                                                   ZI
Addr:                                                                                    City                                                         ST           P


ACCT LN         0001        BFY:                   Period:                     Event Type:                               Line Amount:
REF DOC:                                                                                                   REF Type:                           REF ACTG Line:               
ACCT Line Desc:

 FUND   / SUB           DEPT       UNIT    / SUB             APPR                     OBJT / SUB                  REV / SUB                   BSA / SUB
                                                                                                                                                               
OBSA    / SUB           DEPT OBJ    DEPT REV                        LOC / SUB                ACTY / SUB            FUNC / SUB                         REPT /      SUB
                                                                                                                                                                      
TASK    / SUB          TASK ORD    MJR PRG     PROGM                PHASE      PRG PERIOD
                                                                        

ACCT LN         0002        BFY:                   Period:                     Event Type:                               Line Amount:
REF DOC:                                                                                                   REF Type:                           REF ACTG Line:               
ACCT Line Desc:

 FUND   / SUB           DEPT       UNIT    / SUB             APPR                     OBJT / SUB                  REV / SUB                   BSA / SUB
                                                                                                                                                               
OBSA    / SUB          DEPT OBJ    DEPT REV                     LOC / SUB               ACTY / SUB                FUNC / SUB                           REPT /     SUB
                                                                                                                                                                      
TASK    / SUB          TASK ORD    MJR PRG     PROGM                PHASE      PRG PERIOD
                                                                        


ACCT LN         0003        BFY:                   Period:                     Event Type:                               Line Amount:
REF DOC:                                                                                                   REF Ttype:                          REF ACTG Line:               
ACCT Line Desc:

 FUND   / SUB           DEPT       UNIT    / SUB             APPR                    OBJT / SUB                  REV / SUB                    BSA / SUB
                                                                                                                                                               
OBSA    / SUB           DEPT OBJ   DEPT REV                     LOC / SUB               ACTY / SUB                FUNC / SUB                          REPT /      SUB
                                                                                                                                                                      
TASK    / SUB          TASK ORD    MJR PRG      PROGM               PHASE          PRG PERIOD
                                                                        


ACCT LN         0004        BFY:                   Period:                     Event Type:                               Line Amount:
REF DOC:                                                                                                   REF Type:                           REF ACTG Line:               
ACCT Line Desc:

 FUND   / SUB           DEPT       UNIT    / SUB             APPR                    OBJT / SUB                  REV / SUB                    BSA / SUB
                                                                                                                                                               
OBSA    / SUB           DEPT OBJ   DEPT REV                     LOC / SUB               ACTY / SUB                FUNC / SUB                          REPT /      SUB
                                                                                                                                                                      
TASK    / SUB          TASK ORD    MJR PRG      PROGM               PHASE          PRG PERIOD
                                                                        


ACCT LN     0005            BFY:                   Period:                     Event Type:                               Line Amount:
REF DOC:                                                                                                   REF Type:                           REF ACTG Line:               
ACCT Line Desc:

 FUND   / SUB           DEPT       UNIT    / SUB             APPR                     OBJT / SUB                  REV / SUB                   BSA / SUB
                                                                                                                                                               
OBSA    / SUB           DEPT OBJ   DEPT REV                     LOC / SUB               ACTY / SUB               FUNC / SUB                            REPT /     SUB
                                                                                                                                                                      
TASK    / SUB          TASK ORD    MJR PRG         PROGM            PHASE          PRG PERIOD
                                                                        

TA         (PERM)                                                                                                                                           $ 0.00
State of Iowa TA (PERM)                    Doc # 0                                                                               Dept. Name
Employee Vendor
#:
                        0                                                                Name:         Last            First
                                                                                                                                                                  ZI
Addr:                                                                                    City                                                        ST           P


ACCT LN         0006     BFY:                      Period:                     Event Type:                              Line Amount:
REF DOC:                                                                                                   REF Type:                          REF ACTG Line:               
ACCT Line Desc:

 FUND   / SUB           DEPT       UNIT    / SUB             APPR                     OBJT / SUB                 REV / SUB                   BSA / SUB
                                                                                                                                                              
OBSA    / SUB           DEPT OBJ    DEPT REV                        LOC / SUB                ACTY / SUB            FUNC / SUB                        REPT /      SUB
                                                                                                                                                                     
TASK    / SUB          TASK ORD    MJR PRG     PROGM                PHASE      PRG PERIOD
                                                                        

ACCT LN         0007     BFY:                      Period:                     Event Type:                              Line Amount:
REF DOC:                                                                                                   REF Type:                          REF ACTG Line:               
ACCT Line Desc:

 FUND   / SUB           DEPT       UNIT    / SUB             APPR                     OBJT / SUB                 REV / SUB                   BSA / SUB
                                                                                                                                                              
OBSA    / SUB          DEPT OBJ    DEPT REV                     LOC / SUB               ACTY / SUB               FUNC / SUB                           REPT /     SUB
                                                                                                                                                                     
TASK    / SUB          TASK ORD    MJR PRG     PROGM                PHASE      PRG PERIOD
                                                                        


ACCT LN         0008     BFY:                      Period:                     Event Type:                              Line Amount:
REF DOC:                                                                                                   REF Type:                          REF ACTG Line:               
ACCT Line Desc:

 FUND   / SUB           DEPT       UNIT    / SUB             APPR                    OBJT / SUB                  REV / SUB                   BSA / SUB
                                                                                                                                                              
OBSA    / SUB           DEPT OBJ   DEPT REV                     LOC / SUB               ACTY / SUB               FUNC / SUB                          REPT /      SUB
                                                                                                                                                                     
TASK    / SUB          TASK ORD    MJR PRG      PROGM               PHASE          PRG PERIOD
                                                                        


ACCT LN         0009     BFY:                      Period:                     Event Type:                              Line Amount:
REF DOC:                                                                                                   REF Type:                          REF ACTG Line:               
ACCT Line Desc:

 FUND   / SUB           DEPT       UNIT    / SUB             APPR                    OBJT / SUB                  REV / SUB                   BSA / SUB
                                                                                                                                                              
OBSA    / SUB           DEPT OBJ   DEPT REV                     LOC / SUB               ACTY / SUB               FUNC / SUB                          REPT /      SUB
                                                                                                                                                                     
TASK    / SUB          TASK ORD    MJR PRG      PROGM               PHASE          PRG PERIOD
                                                                        


ACCT LN     0010         BFY:                      Period:                     Event Type:                              Line Amount:
REF DOC:                                                                                                   REF Type:                          REF ACTG Line:               
ACCT Line Desc:

 FUND   / SUB           DEPT       UNIT    / SUB             APPR                     OBJT / SUB                 REV / SUB                   BSA / SUB
                                                                                                                                                              
OBSA    / SUB           DEPT OBJ   DEPT REV                     LOC / SUB               ACTY / SUB               FUNC / SUB                           REPT /     SUB
                                                                                                                                                                     
TASK    / SUB          TASK ORD    MJR PRG         PROGM            PHASE          PRG PERIOD
                                                                        

 TA (PERM)                                                                                                                                                 $ 0.00

				
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posted:8/14/2014
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