Application For Advance On Travel Expense Form
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1OFFICE OF THE COMPTROLLER
STATE OF FLORIDA
Application for Advance on Travel Expense
Payee:
ID #____________________________
Headquarters:
INDEX: ___________________________
Travel Period: ___________ thru ___________ Destination: ___________ __________
(date)
(date)
(from)
(to)
Type of Travel: Regular
Conference or
Convention
Purpose of Travel:_______________________________________________________
Justification: ___________________________________________________________
Estimated Cost of Travel:
* $__________ per day x _________ days = $____________
** Transportation, if privately
owned vehicle:
$____________
Incidental Expenses:
Type: __________________________
Type: __________________________
Total Incidental Expenses:
$____________
Total Estimated Expenses:
$____________ (x 80%)
Travel Advance Allowed:
$____________
** If the per day allowance exceeds $80.00, an explanation must be furnished.
** Estimated cost for common carrier and rental charges billed directly to the state shall not
be included in travel advance calculation.
I hereby certify that the above estimated expenses are anticipated to be incurred by me as necessary
traveling expenses in the performance of my official duties of the Agency; attendance at a conference or
convention directly relates to the official duties of the Agency; any meals or lodging included in a registration
fee have been deducted from this travel advance request. If the travel advance exceeds the actual travel
expenses incurred, I will refund to the State of Florida the remaining unexpended funds within 30 days after
completion of the travel period.
Employee Signature: ___________________________________________________
Title:_____________________________ Date Prepared: ______________________
Pursuant to Section 112.061, Florida Statutes, I hereby do certify or affirm that the above
anticipated travel will be on official business of the State of Florida.
Supervisor Signature: __________________________________________________
Title:_____________________________ Date Prepared: ______________________
FORM C-676 TA
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