HASKINS LABORATORIES - EXPENSE ACCOUNTING FORM

 

 

Date (s) expenses incurred:      _______________________________            # DAYS ________

 

Purpose:                                   _______________________________

Allocation:                               ___________

*********

Transportation:   (Effective January 2007 mileage rate increases to .485 mile)

 

From:             ____________________            To:            ___________________

 

            via:            ____________________ ** ( ____________miles @ .48 1/2       $____________

 

From:             ____________________            To:            ___________________

 

            via:            ____________________ ** ( ____________miles @  .48 1/2       $____________

 

**Taxi ____________**Parking ___________ **Tolls____________             $____________

 

                                                            Total Transportation costs:                              $____________

Hotel:

 

            Number of days ____________ at $____________            $_____________

           

            Number of days ____________ at $____________   $_____________

 

                                                            Total Hotel Charges:                                         $ ____________

Meals:

 

            Breakfast           __________ x 10.00     $ _____________

            Lunch                __________ x 12.00     $ _____________

            Dinner               __________ x 24.00     $______________

 

                                                            Total of Cost of Meals:                            $ ____________

 

Other Items:

___________________                      $______________

________________________            $______________

                                                            Total other items:                                       $ ______________                       

                                                            Registration:                                              $ ______________

 

                                                            TOTAL EXPENSES                               $ ______________

 

                                                            LESS ADVANCE                                   $ ______________

 

                                                            BALANCE DUE                                     $ ______________

 

 

____________________________

SUBMITTED BY and certifying that                                    DATE PAID        ______________

I will not be reimbursed by any other source.                         CHECK #             ______________

APPROVED BY: __________________                            AMT. PAID          ______________

** ORIGINAL Receipts are needed to be reimbursed!!