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					                                                                                 Traveler Name:         _____________________________________ Trip Dates: From (M/D/Y) _________ Through (M/D/Y) __________
                                                                                 Street Address:        _____________________________________ Trip Locations: ______________________________________________
                                                                                 City, State, Zip:      _____________________________________ Trip Purpose: ______________________________________________
                                                                                              Hold check for _________________________________                       Vendor #:______________________________

                                                                                                                                           Please report all expenses in U.S. Dollars (see Instructions)
The Domestic and Foreign Missionary Society of the Protestant Episcopal Church




                                                                                                                            Meals                                  Lodging                              Transportation Expenses                             Miscellaneous
                                                                                                                                                                                                                                   Personal
                                                                                                                                                                    Lodging                                        Local           Vehicle
                                                                                     Date        Traveler's    Traveler's     Traveler's                          (room and Airfare / Train /                    (e.g., taxi;    (plus tolls &   Tel/Fax/
                                                                                   (M/D/Y)       Breakfast      Lunch          Dinner         Entertainment
                                                                                                                                                              3
                                                                                                                                                                  taxes only)   Bus 1,3                         auto rental 1)    parking) 2     Internet        Tips        Other 3
               815 Second Avenue, New York, New York 10017
                    TRAVEL AND EXPENSE REPORT




                                                                                                                                                                                                                                                                                       UPDATED JUNE 2011
                                                                                   TOTAL         $       -     $      -      $         -      $         -         $            -            $             -     $           -    $       -       $    -      $       -   $        -

                                                                                 SUMMARY EXPENSES                                                                                       SIGNATURES
                                                                                                                                                                  Controller's Office
                                                                                  Category        Account Number                                  Total                 Only            Traveler:                                                            Date:
                                                                                    Meals       - - 8232 -                                    $        -                                Authorized by:                                                       Date:
                                                                                  Lodging       - - 8233 -                                    $        -                                Reviewed by:                                                         Date:
                                                                                   Travel       - - 8231 -                                    $        -                                Controller:                                                          Date:
                                                                                    Misc.       - - 8234 -                                    $        -                                Obligation #:                                                        Date:
                                                                                 Total Expenses                                               $        -                                Check #:                                                             Date:
                                                                                 Less Advance received
                                                                                                                                                                                        1
                                                                                 Account Number:      - -     -0000                                                                         Ticket, original receipts and/or auto rental approval letter must be attached
                                                                                                                                                                                        2
                                                                                 Less DFMS paid (e.g., via A & I Travel)         Invoice                                                   $0.51 Jan-Jun 2011; $0.555 July-Dec 2011 per mile plus tolls and parking (please
                                                                                 No. from Ticket Stub                                                                                   itemize on reverse)
                                                                                                                                                                                        3
                                                                                 Reimbursement due Traveler (or to DFMS)                      $         -                                       Please itemize on reverse

                                                                                                                                                            UPDATED DECEMBER 2009
                                                                                 Please read instructions on last page and the reimbursement guidelines posted online at: http://www.episcopalchurch.org/finance_17451_ENG_HTM.htm
                                                                                 ITEMIZED EXPENSES

                                                                                 Entertainment
                                                                                     Date             Place of Entertainment             Cost             Names of Individuals Entertained                          Business Purpose
The Domestic and Foreign Missionary Society of the Protestant Episcopal Church
               815 Second Avenue, New York, New York 10017
                    TRAVEL AND EXPENSE REPORT




                                                                                 Auto Rental Expenses (attach authorization letter) and Miscellaneous Expenses (specify)
                                                                                     Date        Amount                         Description                             Date          Amount                           Description




                                                                                 Personal Automobile Use (Reimbursed at $0.51 per mile; gasoline is not reimbursable)
                                                                                     Date                 From/To City                   Miles                  Persons Transported                                    Comments




                                                                                        Foreign Currency (list)          Conversion Rate per US Dollar (e.g., 20 pesos per USD)              Date/s of Conversion (average for travel dates)




                                                                                                                                                 UPDATED DECEMBER 2009
                                                                                 INSTRUCTIONS


                                                                                 Please type or print clearly. Please securely attach receipts (with tape) to blank sheets of 8 1/2 by 11 paper (using both sides to help the environment).



                                                                                 Expenses can be reimbursed only by submitting a properly completed and approved Travel & Expense Report form. This Form must be accompanied by original
The Domestic and Foreign Missionary Society of the Protestant Episcopal Church




                                                                                 receipts or stubs for all expenditures other than tips . The completed form should be forwarded to your Supervisor or meeting organizer for approval and submission to
                                                                                 the Controller's Office within 21 calendar days following each trip or incurring entertainment and telephone expenses. Expenses submitted after 60 days will not be
                                                                                 reimbursed.
                                                                                 If the U.S. dollar amounts stated on the Form are derived after converting from a foreign currency, please include a copy of the source document used for conversion.
                                                                                 This document should clearly show the rate or conversion factor that was used in the computations. We suggest using the converter available at
                                                                                 http://www.oanda.com/convert/fxhistory.
               815 Second Avenue, New York, New York 10017




                                                                                 Expenses that are generally subject to reimbursement
                    TRAVEL AND EXPENSE REPORT




                                                                                 The following are usually accepted for reimbursement: transportation, lodging, meals, and certain miscellaneous expenses. Details are provided in the Guidelines for
                                                                                 Official Travel available at http://www.episcopalchurch.org/finance_17451_ENG_HTM.htm


                                                                                 Expenses that are not subject to reimbursement
                                                                                 Any expenses not specifically addressed in the Guidelines as reimbursable must have prior written explanation and approval. Non-reimbursable expenses include but are
                                                                                 not limited to the following: Spouse's travel expenses; dependent care; pet care; supply clergy to substitute for clergy on official business; lost pay; use of frequent-flyer
                                                                                 miles; additional travel insurance; luggage purchase or replacement; unofficial (personal) entertainment; in-room movies; barber and beauty services; newspapers and
                                                                                 magazines; sightseeing; medical services; motor vehicle fines; "no show" charges for hotels, car rental and limousines; charge card late fees and expenses; alcoholic
                                                                                 beverages (Exceptions may be made for alcoholic beverages for official entertainment)


                                                                                 Submitting a Request for Reimbursement
                                                                                 Receipts should be taped or stapled to blank sheets of letter sized paper, and properly spaced so that all the numbers on each receipt are clearly identifiable. These blank
                                                                                 sheets should then be attached to the T & E form. We request that you not bunch and staple receipts one behind the other.
                                                                                 Please direct all requests for reimbursement to the staff person through whom the meeting arrangements were made.

                                                                                 Requests for reimbursement for group travel for Members of Committees, Commissions, Agencies and Boards of the General Convention or Executive Council should be
                                                                                 sent to: Cheryl Dawkins, Staff Assistant, General Convention Office, The Episcopal Church Center, 815 Second Avenue, New York, NY 10017, Tel: (212-716-6145)




                                                                                                                                                     UPDATED DECEMBER 2009

				
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