EXPENSE REIMBURSEMENT
First Name
Last Name
SS#/Employee ID#
Received On:
Activity Dates
Title of Activity
LIST ALL THE EXPENSES IN THE CATEGORIES LISTED BELOW – PLEASE PRINT LEGIBLY
*Date
**Description
*Registration
*Transportation
*Lodging
*Meals
*Misc
Total
Sub Total
ORIGINAL RECEIPTS AND APPROPRIATE DOCUMENTATION MUST BE ATTACHED.
Keep copies for your record
TOTAL
VEHICLE INFORMATION
MAKE/MODEL CAR:
BEGINNING MILEAGE:
LICENSE NUMBER:
ENDING MILEAGE:
ODOMETER READING:
MILES DRIVEN:
I have read the Official District Travel Memo printed on the back side of this form and hereby certify that expenditures claimed are true and
correct, incurred according to the law and City College regulations, and in connection with official business of City College of San Francisco.
________________________________________________ ______________________ ____________________
Applicant’s Signature
Telephone
Date
OFFICE USE ONLY
__________________________________________ $_________________ ___________________
Payment Authorization Signature Refund Amount Date
College Appropriation Number
Funding Source
FUND
ORGN
ACCT
PROG
ACTV
AMOUNT
POSTED BY
Grant#: ____________
PD#: _______________
MR: 5/29/2007
Official District Travel Memo
1.
NOTE:
All documents must be submitted within TEN (10) business days after the activity ends, or you may not be reimbursed. ORIGINAL paid receipts are
required for business