Relocation Reimbursement Form - Excel by shh98614

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									University of Vermont
Relocation Expense Reimbursement Form                                                                                                                                   (revised 7/1/2011)



Name
Emplid
Hire/Start Date:
Moving from:                                to                                              , VT

Note: An original receipt evidencing payment must be attached to support each item.
Expenses are limited to those incurred by new hire and immediate family members belonging to both "old" and "new" household.



Qualified (Deductible/Nontaxable) Moving Expenses
                                                                                 1                  2                3                  4                    5          Total
Date(s) of relocation (mm/dd/year)

Household Goods
     Commercial moving company (attach bill of lading)                               0.00               0.00             0.00               0.00                 0.00           0.00
     Optional insurance on items such as furniture                                   0.00               0.00             0.00               0.00                 0.00           0.00
     In-transit storage, up to 30 consecutive days                                   0.00               0.00             0.00               0.00                 0.00           0.00
     Rental truck or trailer                                                         0.00               0.00             0.00               0.00                 0.00           0.00
     UPS/USPS/other parcel shipping                                                  0.00               0.00             0.00               0.00                 0.00           0.00
     Shipment of vehicle(s) not used in the move                                     0.00               0.00             0.00               0.00                 0.00           0.00
     Packing supplies                                                                0.00               0.00             0.00               0.00                 0.00           0.00
     Shipment of household pet                                                       0.00               0.00             0.00               0.00                 0.00           0.00

Transportation
     Mileage for personal vehicle (one-way) at standard moving rate, or                             Miles:                      @ $0.19/mi (effective 1/1 - 6/30/11):           0.00
                                                                                                    Miles:                      @ $0.235/mi (effective 7/1/2011):               0.00
             Gasoline:
                Personal auto(s)                                                     0.00               0.00             0.00               0.00                 0.00           0.00
                Rental truck                                                         0.00               0.00             0.00               0.00                 0.00           0.00
      Tolls (one-way)                                                                0.00               0.00             0.00               0.00                 0.00           0.00
      Airfare (one-way)                                                              0.00               0.00             0.00               0.00                 0.00           0.00

Lodging during move (local is limited to 1 night)                                    0.00               0.00             0.00               0.00                 0.00           0.00

            Total Qualified Moving Expenses                                          0.00               0.00             0.00               0.00                 0.00           0.00         0.00




Nonqualified (Non-deductible/Taxable) Moving Expenses
                                                                                 1                  2                3                  4                    5          Total
Meals (excluding alcohol) during relocation                                          0.00               0.00             0.00               0.00                 0.00           0.00



Date(s) of Househunting Trip (mm/dd/year)
Househunting Trip
     Roundtrip Airfare                                                               0.00           0.00                 0.00               0.00                 0.00           0.00
     Rental car                                                                      0.00           0.00                 0.00               0.00                 0.00           0.00
     Mileage for personal vehicle (one-way) at standard moving rate, or                             Miles:                      @ $0.19/mi (effective 1/1 - 6/30/11):           0.00
                                                                                                    Miles:                      @ $0.235/mi (effective 7/1/2011):               0.00
      Gasoline:
            Personal auto(s)                                                         0.00               0.00             0.00               0.00                 0.00           0.00
            Rental car                                                               0.00               0.00             0.00               0.00                 0.00           0.00
      Meals (excluding alcohol)                                                      0.00               0.00             0.00               0.00                 0.00           0.00
      Lodging                                                                        0.00               0.00             0.00               0.00                 0.00           0.00

Date(s) of Temporary Lodging (mm/dd/year)
Temporary Lodging, local, in excess of one-night                                     0.00               0.00             0.00               0.00                 0.00           0.00


Storage in excess of 30 days                                                         0.00               0.00             0.00               0.00                 0.00           0.00

Other (describe):                                                                    0.00               0.00             0.00               0.00                 0.00           0.00


            Total Non-Qualified Moving Expenses                                      0.00               0.00             0.00               0.00                 0.00           0.00         0.00

                                                                                                                                   Total Moving Expenses             0.00
Certification:
I have reviewed the University's Relocation Policy. I am a full-time employee whose relocation meets the IRS' "distance" and "time" tests. I have properly classified
all expenses as either "qualified" or "nonqualified" in accordance with IRS guidelines. My qualified relocation expenses are limited to one single trip by
the shortest and most direct route in accordance with IRS guidelines. Each item is supported herein by an original receipt. I have not claimed, and will not claim,
a moving expense deduction on my income tax return for qualified expenses reimbursed by the University.


Employee/New Hire Signature:                                                                Date:

I have reviewed this Relocation Expense Reimbursement Form for completeness and accuracy against the University's Relocation Policy.
The new hire is a full-time employee of the University whose relocation meets the IRS' "distance test" and "time test." Expenses incurred are properly classified
as either "qualified" or "nonqualified" in accordance with University policy. Each item is supported herein by an original receipt.

    Administrator Name                               Title                                               Signature                                         Date                        Phone

            Department/College Administrator: please attach Relocation Expense Reimbursement Form to Check Request Form,
                and submit to Procurement Services, 19 Roosevelt Highway, Suite 120, Colchester, VT 05446

								
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