Travel Voucher

ADVERTISEMENT

STATE OF ILLINOIS
Reset Form
Form C-10
Revised 1/13
Travel Voucher
Court Reporting Services
Disposition of Copies
1. Comptroller
325 W. Adams St., Room 307
2. Traveler
3. Agency
Springfield, IL 62704
4. Agency
5. Traveler
Agency Name and Address
PAYMENT OF INTEREST MAY BE
1. Social Security Number
3. Voucher No.
2. Traveler Name and Address - Payee
AVAILABLE IF THE STATE FAILS
4. Voucher Date
LAST NAME
FIRST NAME
MIDDLE INITIAL
TO COMPLY WITH THE STATE
5. Appropriation Account Code
OR BUSINESS NAME
0001-36065-1290-0000
PROMPT PAYMENT ACT, 30 ILCS 540.
6. Headquarters
7. Residence
11. Auto
8. Date
15. Meals or/
16. Other Expenses
17. Line
9. Departed From
10. Arrived At
12. Auto
Mileage
$0.56
Reimb.
13. Trans
14. Lodging
Place
Time
Place
Time
Per Diem
Item
Amount
Totals
21. State License
22.
23.
24.
25.
26.
SUB
27.
19. Amount
18. Exp. Obj.
20. CFDA No.
Plate Number
TOTALS
31. Traveler Comments/Explanations
1264
1291
29. Total
1295
Amount _______
28. Total Exp.
30. Purpose of Travel
This certifies that the travel shown above was required by the official duties of the
I certify that, in accordance with Section 12 of "An Act in Relations to State Finance," the
traveler named to my personal knowledge, or as indicated by records submitted to
above amount is correct and just; that the detailed items charged for subsistence were
me. If applicable, the reporting requirements of section 5.1 of the Governor's Office
actually paid; that the expenses were occassioned by official business or unavoidable
of Management and Budget Act have been met.
delays requiring the stay at hotels for the time specified; that the journey was performed with
all practicable dispatch by the shortest route usually traveled in the customary reasonable
manner; and that I have not been furnished with transportation or money in lieu thereof for
any part of the journey therein charged for.
Division Head, Supt., Chief
Date
Approved-Agency Head
Date
Date
Traveler Signature

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Life
Go