STATEMENT OF TRAVEL EXPENSE
NAME
ADDRESS
Dept
Purpose
of Trip
Return Check to:
Date of Trip
DATE OF
EXPENSE
TO
FROM
MODE OF
TRAVEL
TO
Date
Bldg
To
MILEAGE
PARKING
TOLLS
FARE
MILES
TOTAL
$ EXTENDED
0.00
0.00
0.00
0.00
DATE OF
EXPENSE
0.00 0.00
0.00
SUB-TOTAL
MEALS
SUB-TOTAL
HOTEL
TAXI
OTHER
TIPS
PHONE
DESCRIPTION
0.00
0.00
0.00
0.00
0.00
0.00
AMOUNT
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
TOTAL THIS PAGE
D
I
S
T
R
I
B
U
T
I
O
N
SPEEDTYPE
ACCOUNT
JOURNAL DESCRIPTION - 11 POS
AMOUNT
Are you considered a non-resident alien for tax purposes?
TOTAL PREV PGS.
0.00
TOTAL EXPENSES
LESS ADVANCE
0.00
0.00
DUE UNIVERSITY
DUE TRAVELER
✔
Yes
No
APPROVAL - Traveler's Supervisor:
SIGNATURE / CERTIFICATION OF TRAVELER:
"I certify that all expenses are in accordance with the University Travel Policy. I also
certify that the reimbursement for charges are permissible under sponsor guidelines
where applicable and charges to federally sponsored projects do not include alcohol. "
Signature
Signature
Phone
Printed Name
Phone
INSTRUCTIONS:
1. Attach all original receipts to this form.
2. Complete an on-line payment request form for this traveler.
3. Print check request form, enter check request number in
Please record check
request no. here
the box on the right and forward both to Accounts Payable.
Rev. 5/14/2004