Free 49630.pdf - Indiana

TRAVEL ADVANCE
State Form 49630 (2-00) Approved by State Board of Accounts-2000

RESET FORM

Name of Employee

Division/Section

Dates of Travel

Mode of Travel

Estimated Expenses: $
Hotel

$
Bus, train, or airfare

$
Registration

$
Total

0.00

Purpose of Trip: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

Approved by: __________________________ Date: _______________________ Travel Advance: Check Date _____________ Check Number ______ Amount $___________

Employee Certification: I understand that this cash advance is to be used for allowable hotel, transportation, and registration costs relating to this trip and is not made for meal and other costs covered by per diem. I also understand that I am to submit a properly completed travel voucher within one week after the completion of this trip and that I am to return the amount of the cash advance promptly after receiving the travel reimbursement from the state. __________________________________ Signature of Employee ______________ Date

Reimbursement of Travel Advance: Date Received: __________ Amount Received: __________

Employee's Check Number: ____________