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)