RIVERSIDE UNIFIED SCHOOL DISTRICT EXPENSE CLAIM FORM
1. This form must accompany all district employee's reimbursement requests.
2. Original itemized receipts are required for expense claim reimbursements. (Tape receipts to a blank 8-1/2" by 11" paper.)
3. R.U.S.D. Conference Request Form and a copy of the conference brochure/flyer is required for conference expenses.
4. The current IRS Mileage Rate for January - December 2007 is: $0.485
5. Managers/confidentials - subtract non-reimburseable miles (first 10 miles going to/last 10 miles returning from)
6. Employee's position title and signature must appear on the bottom of this form.
7. Claim must be approved by the employee's supervisor.
Please allow about four weeks for payment.
(Please Print Your Legal Name) Send Check (Checks are usually sent to worksites)
Purpose of Trip: Purpose of Purchase:
Period From: To:
Transportation Expense Other Expenses
Date From: To: Miles Item/Purpose (Original Receipts Attached) Amount
Total Miles 0.00
Total Miles x Current Rate = Total Mileage Reimbursement $0.00 Total Expenses $0.00
Charge Account(s) Listed Below Amounts Total Reimbursement Amount $0.00
(Your Supervisor's Approval Signature)
I hereby certify that the above was incurred in the performance of my duty as: Claim is made for reimbursement as itemized above.
Position Title: Signature:
(Sign all copies)
Business Office Use Only
Vendor #: Direct Pay #: Claim #: Date Paid:
Created Aug. - 2007 NAR/SLM