Free Expense Form-PDF - Vermont


File Size: 81.1 kB
Pages: 1
File Format: PDF
State: Vermont
Category: Court Forms - State
Word Count: 206 Words, 1,424 Characters
Page Size: 792 x 612 pts (letter)
URL

http://www.vermontjudiciary.org/eforms/Expense%20Form.pdf

Download Expense Form-PDF ( 81.1 kB)


Preview Expense Form-PDF
Employee # * Name * Residence * Work Station *
6/24/2005

Paygroup *

STATE OF VERMONT
REIMBURSEMENT OF TRAVEL EXPENSE FORM
Pos #> *
NAME OF DEPARTMENT

Rev. 9/1/2005 Form No APER10

Page 1 of 1

Clear Form
GRAND TOTAL
7

YEAR
LINE #: 1 2 3 4

5

6

8

9
LINE

Paper Users write ''mm/dd''
DATE* TOTALS FUND DEPT ID

CHART OF ACCOUNT CODES
PROG CLASS PROJECT/GRANT

CODES

ENTER NUMBER OF MILES ONLY IN THIS SECTION

MILES

CODES

ENTER AMOUNT OF REIMBURSEMENT REQUESTED

AMOUNT

column # #
1 2 3 4 5 6 7 8 9

List Towns or Cities to which you traveled (*If meals taken)

Explain Business Purpose or Reason for Travel Expense

Departed

TIME

Returned

WE THE UNDERSIGNED CERTIFY UNDER THE PENALTIES OF PERJURY THAT THE INFORMATION GIVEN ON THIS FORM REPRESENTS THE ACTUAL EXPENSES TO WHICH THIS EMPLOYEE IS LEGALLY ENTITLED Employee Signature
LODGING RT = OUT-OF STATE RM = IN-STATE MEALS: "BREAKFAST" BT = OUT-OF-STATE TAXED XB = OUT-OF-STATE NOT TAXED BM = IN-STATE TAXED BX = IN-STATE NOT TAXED MEALS "LUNCH" LT = OUT-OF-STATE TAXED XL = OUT-OF-STATE NOT TAXED LM = IN-STATE TAXED LX = IN-STATE NOT TAXED

Date

Supervisor Signature
MEALS "DINNER" ST = OUT-OF STATE TAXED XS = OUT-OF-STATE NOT TAXED SM = IN-STATE TAXED SX = IN-STATE NOT TAXED OTHER CODES MM = MILEAGE IN-STATE MT = MILEAGE OUT-OF-STATE CT = INCIDENTALS OUT-OF-STATE CM = INCIDENTALS I N-STATE PT = OUT-OF-STATE PM = IN-STATE

Date
OTHER TRANSPORTATION