Travel Claim & Expense Report Settlement Of Travel Advances Form - The University Corporation, San Francisco State
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THE UNIVERSITY CORPORATION, SAN FRANCISCO STATE
P.O. BOX 320160. SAN FRANCISCO, CA 94132-0160
TRAVEL CLAIM & EXPENSE REPORT
SETTLEMENT OF TRAVEL ADVANCES
DC#
(Grants/Contracts only)
CHARTFIELD:
ACCOUNT
-
FUND
-
DEPT ID
-
PROJECT
Date:
_ _ _ _ _ _ - FN1 _ _ - 9 1 0 0 - 9 8 0 _ _ _ _ _
FUND #
_ _ _ _ _
_ _ _ _ _
_ _ _ _ _ _ _ _
MAKE CHECK PAYABLE TO:
TRAVELER'S NAME:
PROJECT CONTACT
(Last, First, MI)
ADDRESS:
PROJECT PHONE #
CITY
STATE
ZIP CODE
CHECK DISTRIBUTION:
Legal resident of the United States?
Mail to payee's address
Yes
Hold/Call for pickup
No
Immigration Status:
Passport #:
ph #
LOCATION AND PURPOSE OF TRIP:
Please note : a copy of the traveler's authorization of Travel must be attached to the claim.
PerDiem
Train,
Taxi,
Reg. Fees
Date
Time
(every 24 hr
Airfare,
Shuttle,
Private Auto
& Other Bus.
Lodging
period)
Bus, etc
Parking
Miles
Amount
Expense
Total
mm/dd/yyyy
hh:mm
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Day 10
Totals
* Attach itemized list, receipts and explanation
Grand Total
Note: Original receipt(s) required for all items $25, or greater.
Less Advance/ DC #
I hereby certify that the above is true statement of the travel expenses incurred in
Balance Due to Traveler: OR
accordance with applicable UCorp policy, All items shown here are for legitimate
Balance Due to UCorp:
business purposes and are properly reimbursable from the project charged.
Furthermore, I have not received payment nor will seek duplicate reimbursement
for the above travel expense from SFSU or any other sources.
AUTHORIZED SIGNATURE
CLAIMANT'S SIGNATURE
DATE
DATE
ACCOUNTING USE ONLY
Acct:
Inv Nbr:
Vendor:
Inv Amt:
Rept Amt:
Inv Date:
Spec Msg:
Dup Inv:
Date Received
Date Received
A/Processing
Approved For Allowability
By UCorp
BY A/P Dept
By:_______________
By:____________________
Date:__________________
Date:_____________
Voucher #______________
REV 04.2014
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