Monthly Employee Expense Request

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					                                                                                                                                                                        FIN-14 ATTACHMENT A

                                   MULTNOMAH COUNTY MONTHLY MILEAGE/EXPENSE REPORT
NAME:

Cost Center/WBS:                                                            Personnel #:                                           MONTH / YEAR:



INSTRUCTIONS - Employee
This monthly mileage / expense report is used to request reimbursement for work related use of your personal automobile. Mileage for local training or out-of town travel may be reimbursed using this form
when there are no other associated costs such as registration, per diem, hotel, etc. This form also may be used to request reimbursement for all miscellaneous allowable expenses such as parking, small
supplies purchase, etc. To complete this form:

        a.         Complete the employee identification block at the top of this page.
        b.         On Mileage Worksheet, for each trip record the date, travel destination, the reason for travel, your starting odometer, and your ending odometer in the spaces
                   provided. If the trip was for a cost center/wbs other than your home cost center/wbs (the one filled in at the top of the page) record that cost center/wbs number or
                   name in the Alternate Cost Center/WBS column.

        c.         At the end of the month, add the total miles driven. Use additional sheets if necessary. Carry this number to the front of this form. Add the total miscellaneous
                   expenses for the month and attach original receipts. Carry this number to the front of this form. The form is designed to auto-total when completed electronically.

        d.         Complete the Certification and Reimbursement Calculation section. Forward to your dept A/P contact. To Print form and information: Select FILE, PRINT & ENTIRE
                   WORKBOOK then OK.

CERTIFICATION AND REIMBURSEMENT CALCULATION (To be completed by employee)
I HEREBY CERTIFY that I have used my personal automobile in traveling the miles                                                 A. Total Miles                                            0.00
indicated on the days shown and for the reasons indicated, and that this travel was                                                   (will auto-populate from prev page)
exclusively in the transaction of County business, and that I have not already been                                             B. Mileage Rate per Mile                         $      0.585
reimbursed for any part of this travel.                                                                                               (Revised Rate 7/1/08)
                                                                                                                                C. Mileage Reimbursement                                 0.00

                                                                                                                                D. Miscellaneous Expenses                                0.00
                   Signature                                                           Date
                                                                                                                                 E. TOTAL REIMBURSEMENT                          $        -


                   Supervisor's Signature                                              Date

                                                                                                                           Use the section below only if expenses are to be charged to
                                                                                                                           other than your home cost center/wbs:
                                                                                                                              LINE    Cost Center       WBS        GL Account        AMOUNT
                                                                                                                               1
                                                                                                                               2
                                                                                                                               3
                                                                                                                               4
                                                                                                                                                                   TOTAL :              $0.00
         5f4d7955-a099-4e88-8d84-abba698126ff.xls                                                                                                                                                  1 of 2
                                                                                                                                                              FIN-14 ATTACHMENT A

MULTNOMAH COUNTY - MONTHLY MILEAGE WORKSHEET                                                                                                                              Revised Rate 7/1/2008

NAME:                                                                                                   MONTH / YEAR:




                                                                                     Y or N: was Pool
                                                                                     .Car Accessible?
              From Address &                              Purpose for Travel                                                         Miles driven
              To (Destination) Address                                                                                                on / after
                                                                (If "Yes" in next
                                ( If County Bldgs,        column, additionally                          Beginning                    July/1/2008        Parking or
              indicate Bldg names only, since addresses   provide brief Reason for                                Ending    Total     Amount          Misc.Expenses         Misc.    DAILY
  Date        are known)                                  using Private Vehicle)                        Odometer Odometer   Miles    Milesx$.585    (Receipts Attached)    Amount    TOTAL
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
                                                                                                                               0.0        $0.00                                               0.00
TOTAL                                                                                                                          0.0        $0.00                             $0.00            $0.00




        5f4d7955-a099-4e88-8d84-abba698126ff.xls                                                                                                                                    2 of 2

				
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