Non-Employee Travel Voucher Form
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1Date ________________________
WESTERN ILLINOIS UNIVERSITY
Voucher
45246
00
Non-Employee Travel Voucher
Number
4550
Cost Center Name ___________________________________________________________________ Cost Center # ____________________ -
Encumbrance TC _________
Exp Class _______
Vendor Number
Payee ________________________________________________________________________________ FEIN/SSN _________________________________
Address _________________________________________________________________________________________________________________________
Requested By ____________________________________________________________________________ Phone Number ___________________________
45246
0.00
TC ______
Ref ______
Desc_____________________________________________
Date ______________
Amt ________________
8. Date
9. Departed From
10.Arrived At
11.Auto
12. Auto
13. Trans
14.
15 Meals
16. Other Expenses
Mileage
Reimburse-
Lodging
or/
Place
Time
Place
Time
Item
Amount
.50
@_____
ment
Per Diem
0.00
0.00
0.00
0.00
0.00
1291
SUBTOTALS--
0.00
1292
TOTAL AMOUNT--
Traveler Comments/Explanations:
Purpose of Travel:
I certify that, in accordance with Section 12 of "An Act in relation to State Finance," the above amount is correct
and just; that the detailed items charged within are taken and verified from memorandum kept by me; that the
amounts charged for subsistence were actually paid, and the expenses were occasioned by official business
or unavoidable delays, requiring my stay at hotels for the time specified; that I performed the journey with all
practicable dispatch, by the shortest route usually traveled, in the customary reasonable manner, and that I
This certifies that the travel shown above was required by the official
have not been furnished with transportation or money in lieu thereof for any part. In consideration of the
duties of the traveler named to my personal knowledge, or as indicated
payment in full by the Board of Trustees of Western Illinois University, I do hereby irrevocably release and
by records submitted to me. If applicable, the reporting requirements of
forever discharge the Board of Trustees of Western Illinois University and its members from all claims,
section 5.1 of the Governor’s Officeof Management and Budget Act
demands, and causes of action which the undersigned, may have now or in the future for any and all loss or
have been met.
expenses resulting from, arising out of, or in any way connected to the aforesaid reimbursement.
_________________________________________________________________________________
_______________________________________________________
Traveler Signature
Date
Fiscal Agent
Date
_________________________________________________________________________________
_______________________________________________________
Vice President (if $1,000 or over)
Date
Purchasing
Date
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