Business Travel Coalition - Excel

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					                                                    Early Learning Coalition of the Nature Coast Travel Reimbursement Form
Employee Name                                                                                                        Telephone Number                                                            Position

SS#                                                                                                                  Headquarters                                                                Residence


Check One          X       Officer/Employee                                                                          Non-Employee/Ind. Contractor                                                OPS


                                                                                                                                                                     Per Diem or Actual                      Vicinity
                   Travel Performed Point of Origin to                                                     Hr of Dept Hr of                                          Lodging Expenses            Map Mileage Mileage               Other Expenses
Date               Destination                                          Purpose of Travel                  Return                       Meals for Travel             Class A & B                 Claimed     Claimed               Amount       Type




                                                                                                                                        Column Total                 Column Total                              0 Total Miles       Column Total Column Total
Statement of Benefit to the Coalition (Conference or Convention):                                                                                                0                           0                 0 at $0.445                        0                   0
Advance:                                     Date                                                                                       Total Expenses                                                                                                                0
RFE #                                        Date                                                                                       Less Advance Received
Check #                                      Date                                                                                       Less Non-Reimbursable Items Included on Purchase Card
                                                                                                                                        Amount Due to Traveler                                                                                                        0
                                                                                                                                        Amount Due to Coalition                                                                                                       0


I hereby certify or affirm that the above expenses were actually incurred by me as necessary travel expenses in the performance
of my official duties; attendance at a conference or convention was directly related to official duties of the agency, and meals or     Pursuant to Section 112.061 (3) (a) Florida Statutes, I hereby certify or affirm that to the best of my knowledge the above
lodging included in a conference or convention registation fee have been deducted from this travel claim, and that this claim is true   travel was on official business of the Coalition and was performed for the purpose(s) stated above.
and correct in every material matter and same conforms in every respect with requirments of Section 112.061, Florida Statutes.          Supervisor's Signature: ______________________________________________________________________
                                              Traveler's Signature:___________________________________________                 Date     Supervisor's Title: __________________________________________________________________________
Prepared: ________________________                                                                                                      Signature Date: _____________________________________________________________________________




ELCNC147: Travel Reimbursement Request Form

				
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