Free Personal Expense Form - Vermont


File Size: 82.3 kB
Pages: 1
File Format: PDF
State: Vermont
Category: Court Forms - State
Word Count: 87 Words, 593 Characters
Page Size: 792 x 612 pts (letter)
URL

http://www.vermontjudiciary.org/eforms/Personal%20expense%20claim.pdf

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STATE OF VERMONT PERSONAL EXPENSE CLAIM
Name Address Social Security No. Position Title Travel Miles Breakfast Town of Residence Department/Board or Commission

Date

Explanation

Amount

Lunch

Dinner

Lodging

Other

Total

GRAND TOTAL I certify under the pains and penalties of perjury, that the foregoing is a correct statement of the time actually spent, mileage actually and constructively traveled, and amounts necessarily incurred or paid by me in the discharge of my duties. (32 V.S.A. 464)

Claimant's Signature

Date FINANCE & MANAGEMENT

Supervisors Approval

Date

AAF6A
(11/95)