Travel Reimbursement Form

TRAVEL REIMBURSEMENT FORM

Group & Individual Travel

If you would like to view the IRS sample of a travel records form see: (if you have Acrobat reader, you can look at an example prepared by the IRS - Daily car Log Weekly Travel Expense )

Name: ___________________________ Month: _____________________

Administration: Division:________________ Position: ____________________

Out of District Travel Expense:

Purpose of travel _______________________________

Destination: ________________________________________

Date of departure:_____________________ Time: ________________

Date of return: ________________________ Time: ________________

Transportation:
Private Car: No. Miles @ $ __________
Public conveyance:
Air or bus transportation (ticket attached)
Limousine or taxi fares
Meals: Breakfast: No. @ $_______ or supported by attached receipt Lunch: No. @ $_______ or supported by attached receipt Dinner: No. @ $_______ or supported by attached receipt Detail of meals: (Includes tips.) No. of guests in party (players, students, associates, customers): ____________________ No. of adults; ___________________ You must attach an explanation of each meal, showing the reason for the meeting, the business purpose, the company
Name: ______________ Name: ______________ Name ______________ Name. ______________ Name: ______________ Name: ______________ Name: ______________
Lodging:
Rooms No. (tickets attached)
Miscellaneous
Participation fees (receipts attached)
Automobile parking
Telephone and telegraph
Other (specify—attach receipts)
Total travel reimbursement claimed


Less: Expenses advanced
Amount due this claim
Amount refunded to employer if claim is less than amount advanced

Out of Dlstrlct Travel:

Receipts are required on oil items for group travel reimbursement.

Signed Claimant: ____________________ Date ______________

Approved Mgr.Principal: ______________ Date: ______________

Approved Business Dept./Acctg. _______ Date: ______________