*02AG014E-001*
OKLAHOMA DEPARTMENT OF HUMAN SERVICES
In-Kind Travel Expense Voucher
Voucher number: Traveler Date From for the month of Purpose of travel To Miles driven
0
, 20
Total I certify that the above information is true and correct to the best of my knowledge. Signature of traveler Traveler Date From Date Approved by Purpose of travel To Date
Miles driven 0
Total: I certify that the above information is true and correct to the best of my knowledge. Signature of traveler Traveler Date From Date Approved by Purpose of travel To Date
Miles driven
Total: I certify that the above information is true and correct to the best of my knowledge. Signature of traveler Date Total miles this voucher: Amount allowed per mile: Total amount this voucher: Approved by Date
0
0
.485
$0.00
OKDHS issued 11-1-2006
02AG014E (SUOA-S-17)
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