Official Expense Voucher

 

DATE: ________________________ COMMITTEE: __________________
EXPENSE PURPOSE: _______________________    
ITEMIZATION:    

_______Mileage

 (_____ miles @ $0.20/Mile)

 $___________

______Air Fare

 (_____________________)

 $___________

               ______ Lodging

( ___/day + $         tax X        )

 $___________

   ______ Meals   

 (_____________________)

 $ ___________

______ Misc     

 (_____________________)

 $ ___________

*Receipts Required;
Others as appropriate              

TOTAL

 $                     

                _______REIMBURSEMENT REQUEST

(OR)  _______TRAVEL ADVANCE REQUEST

The expenses incurred in the discharge of official business of the NCSRC, Inc. from (date)

 ____________to (date) ______________ as itemized above in the sum of _____________ dollars

$ ______________

LESS:                      Travel advance received: (date                                          )

 $ ______________
 

BALANCE DUE REQUESTOR:

 $ ______________

(SUBMIT REFUND WITH VOUCHER)

    
 

REFUND DUE NCSRC:      

$ ______________
     
SUBMIT TO:   (Name & Address) _______________________________________________________________
___________________________________________________________________________________________
     
Above expenses are just and true in all respects. ____________________________________
  (signature)  
     

THIS SECTION FOR OFFICIAL USE ONLY

 

APPROVED BY:                                                                                                                                                                                   Committee Chairperson                       Date 

                                              ________________________________________________   BUDGET LINE # ____________ Treasurer                                               Date

                                                                                                                                                      CHECK# -_____________

 ________________________________________________               
President                                               Date

 COMMENTS:                                                                                                                                                                                  

                                                                                                                                                                                                             

* BOD LODGING paid at hotel rate not to exceed $40.00 (requires a minimum 1 way travel distance of 150 miles or more).