II 0-25 (04/ 10)
Completed only by th l b l ~~c If~~ Board's Office
Agenda Date:
CBS Sign Off
II'.
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COUNTY OF ALAMEDA
OUT-OF-STATE TRAVEL AUTHORIZATION REQUEST
II
AUTHORIZATION NUMBER
'
II
Susan S. Muranishi, County Administrator
Agency I Department Head - Print::....__ _ _ _ _ _ _ _ _ _ Signature _ _ _ _ _ _ _ _ __
TO :
FROM:
SUBJECT:
DATE:
OUT-OF-STATE TRAVEL (OOST) AUTHORIZATION REQUEST
Sept 19, 20 13
I am requesting your approval of the following OOST request prior to the event taking place.
PLEASE TYPE I PRINT LEG I~
'A 6
AGENCY / DEPARTMEN]
DiVISION I UN I11
TRAVELER' S NAM E*
PLEASE TYPE I PRINT LEGIBLY
JOB TITLE I CLASSIFICATION or VEN DOR #
I.
2.
3.
..
*NOTE: The only elrg1ble personal serv1ces contractors are those who are reimbursed travel/events as stated
his/her contractual agreement with the County. Must specify Vendor # above.
111
DETAILS OF TRAVEL
DATES (DURATION) :
From:
_lQ_l_ I
I DESTINATION (City/State): Washington, DC
POINT OF ORIGIN (City/State) : Oakland
PURPOSE OF TRIP :
L 3 L2013
T.Q.;___ffi
/ _2.QD
x CONFERENCE - - MEETING - - SEMINAR
- - TRAINING - -OTH ER
NAME OR TITLE OF EVENT (no acronyms please): Joint Center for Political Economic Studies Place Matters
Convening
COST PER TRANS TICKET
PER PERSON : $: - -0
I. AUDITOR' S MAXIMUM REIMBURSEMENT (per person) : $0
TOTAL COST (Max Reimb/person x no. of travelers):
1::§0 COUNTY TIME-OFF ONLY
$0
ACCOUNTING INFORMATION I FUNDING SOURCE
BUSIN ESS
UNIT
ACCOUNT
No.
FUND
No.
DEPT IDNo.
-
-
-
PROGRAM
No.
PROJECT/GRANT No.
-
f- -
2. NAM E OF FUNDING SOURC E (Please Specifv)·
3. AMOUNT OF FUNDING
4. COUNTY COST AMOUNT (Noted on the Board Agenda)
REQUESTED BY AND RETURN FORM TO:
(PRINT NAM E)
PHONE NUMBER: _ _ _ _ _ _ __
(Q IC)
(SI GNATURE)
TI E LINE : _ _ _ _ __
(DATE)
FAX NUMB ER: _ _ _ __
APPROV ED BY:
DEPT.
(PRINT NAM E)
CAO:
(PRINT NAME)
(SIGNATURE)
7cgj~/J~UR~
(DATE)
r/zJ/Zo;?.
(DATE)