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EXPENSE ACCOUNT STATEMENT
Account of :_________________________ (employee name)
From _____________ to ______________
Reimbursable Expenses Incurred
Lodging $_______________________
Meals $_________________________
Travel [air/train/bus/auto] $________________
Personal automobile _____ miles x ___ cents $____________
???????Parking _____ hours x ______ dollars $______
Others (itemize):
________________ $______________
________________ $______________
________________ $______________
________________ $______________
Total: $________________________
Grand Total: $__________________
Select one
[] Credit to account of _____________________
[] Send check to ____________________________
I certify the above is a true statement and that the expenses claimed were incurred by me on official business.? Receipts for each expense are attached.
_______________________________
Employee
Approved for payment:
By:____________________________
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