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Expense Reimbursement Form
| EXPENSE REIMBURSEMENT FORM |
| Reporter: |
Date of Report: |
| Activity: |
Activity Date: |
| Charge: |
CBA |
DBA |
Other |
| Attach All Receipts (Auditor Requires Receipts for amounts over $75) |
| Expense Description |
Personal Charges |
Association Charges |
TOTAL |
| Meals |
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| Meals |
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| Airfare |
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| Auto Rental |
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| Ground Transportation |
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| Mileage: mi. x $.485/mi= |
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| Lodging |
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| Lodging |
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| Communications |
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| Miscellaneous Tips |
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| Others (itemize) |
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| SUB-TOTAL |
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Total Expenses |
$ |
|
Less Personal Expenses |
$ |
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Less Advance Taken |
$ |
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BALANCE DUE ASSOCIATION (ATTACH CHECK): |
$ |
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BALANCE DUE REPORTER: |
$ |
| Reporter's Signature |
Treasurer’s Approval | | |
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