Ortonville Independent School District #2903 Revised: 01.01.10 Expense Reimbursement Request Form (See page 2 of this form for information on reimbursement policy and procedure) Account Code FD ORG PRO CRS FIN OB J Amount Date: Purpose & Place of Attendance and/or Item Purchased Personal Vehicle Miles Traveled Meal Expense Check Meals B L D Other Travel Expenses Non Travel Expenses Total Miles: X's $.50 Column Column Column (IRS Rate) Total Total Total Total Amount Claimed Authorization Signature I declare under the penalties of law that this account, claim or demand is just and correct and that no part of it has been paid. Signature Date Name Address City, State, Zip Ortonville Independent School District #2903 Expense Reimbursement Request Form Unless specified otherwise in an applicable contract or agreement, the following limits apply to reimbursement of expenses: 1. Mileage currently is $.50 cents per mile (IRS Rate) (Rate Effective 01/01/10) ** When more than one employee is making the same trip at the same time, employees are expected to share transportation to minimize costs. ** 2. Room allowances should be decided with Administrators prior to the event. 3. Parking fees will be reimbursed for full cost with a receipt. 4. If required to leave before 7:00 AM and/or return after 6:00 PM, meals will be reimbursed up to the following limits with receipts: Breakfast: $ 8.00 Lunch: $10.00 Dinner: $17.00 The actual cost above the limits will be reimbursed if the cost is required as part of the meeting package. NOTE: Requests turned in by the 10th of the month, Will be paid at the regular business meeting For the month.