Free travel.pdf - Indiana

Reset a Form
TRAVEL VOUCHER State Form 980 (R2/12-96) Approved by State Board of Accounts, 1996 Approved by Auditor of State, 1996 Document Number Agency Name Date (Month, Day, Year) Agency Number

Post or Station Employee's Name (Last, First, Mi)

Social Security Number

or
Employee's Address Federal I.D. Number

Amount Travel Between Points Month/ Day From To Hour of Departure Arrival Subsistence Lodging Other Expense Expense Travel Expenses Other No. Mileage Expense Miles x .

FUND / OBJECT / CENTER

Amount

FUND / OBJECT / CENTER

Amount

FUND / OBJECT / CENTER

Amount

FUND / OBJECT / CENTER

Gross Amount: Totals

$

0.00
I certify that this voucher is correct, that the travel was authorized, that the claim is a proper charge against the Fund and Center indicated and that payment was authorized.

Pursuant to the provisions and penalties of IC 5-11-10-1, I certify that the foregoing Fund and Center is just and correct, that the amount claimed is legally due, after allowing all just credits, and that no part of the same has been paid.

Signature of Employee

Date (Month, Day, Year)

Signature Authorized by Agency

Date (Month, Day, Year)