DISTRICT 12-I001
Name __________________________________________ SSN: ______________________________ Date____________________
Purpose of Expense: _____________________________ Location: ________________________
Conference: _____________________________ Conference Date: ________________________
Depart Time: _____________________________ Return Time: ________________________
REIMBURSABLE EXPENSES:
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Date |
Per Diem |
Hotel |
Parking/Toll |
Travel Rate |
Miles Traveled |
Travel Cost |
Other |
Total |
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EXPENSES APPROVED BY:
__________________________________________________
Gerald Stegall, Superintendent Date