Form Aud-Exp - Meal Expense/per Diem Voucher For One Day Round Trips - State Of Wyoming
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1STATE OF WYOMING
AUD-EXP
MEAL EXPENSE/PER DIEM VOUCHER
M M D D Y Y
FOR ONE DAY ROUND TRIPS
DATE
USE THE "TAB" KEY TO MOVE THROUGH THE VOUCHER
EMPLOYEE/CLAIMANT INFORMATION
PAYMENT WILL BE MADE BY AGENCY (DEPARTMENT OR DIVISION)
NAME
SSN
IMPORTANT:FOR DESCRIPTION, GIVE REASON FOR BEING AWAYFROM HEADQUARTERS (OFFICIAL BUSINESS AS REASON NOT ACCEPTABLE)
DATE
TRAVEL FROM
TRAVEL TO
TIME LEFT
TIME RETURN BREAKFAST
LUNCH
DINNER
PER DIEM
OTHER
TOTAL
$
-
Normal Shift
DESCRIPTION
to
and CODING:
Hours
DATE
TRAVEL FROM
TRAVEL TO
TIME LEFT
TIME RETURN BREAKFAST
LUNCH
DINNER
PER DIEM
OTHER
TOTAL
$
-
Normal Shift
DESCRIPTION
to
Hours
and CODING:
DATE
TRAVEL FROM
TRAVEL TO
TIME LEFT
TIME RETURN
BREAKFAST
LUNCH
DINNER
PER DIEM
OTHER
TOTAL
$
-
Normal Shift
DESCRIPTION
to
and CODING:
Hours
DATE
TRAVEL FROM
TRAVEL TO
TIME LEFT
TIME RETURN BREAKFAST
LUNCH
DINNER
PER DIEM
OTHER
TOTAL
$
-
DESCRIPTION
Normal Shift
to
Hours
and CODING:
DATE
TRAVEL FROM
TRAVEL TO
TIME LEFT
TIME RETURN BREAKFAST
LUNCH
DINNER
PER DIEM
OTHER
TOTAL
$
-
Normal Shift
DESCRIPTION
to
and CODING:
Hours
DATE
TRAVEL FROM
TRAVEL TO
TIME LEFT
TIME RETURN
BREAKFAST
LUNCH
DINNER
PER DIEM
OTHER
TOTAL
$
-
Normal Shift
DESCRIPTION
to
Hours
and CODING:
DATE
TRAVEL FROM
TRAVEL TO
TIME LEFT
TIME RETURN
BREAKFAST
LUNCH
DINNER
PER DIEM
OTHER
TOTAL
$
-
Normal Shift
DESCRIPTION
to
Hours
and CODING:
TOTAL
$
-
USE ANOTHER VOUCHER IF MORE SPACE IS NEEDED
THE UNDERSIGNED HEREBY CERTIFIES THAT THE
CERTIFICATION
ABOVE EXPENSE ACCOUNT IS CORRECT AND
I CERTIFY, UNDER PENALTY OF PERJURY, THAT THE FOREGOING CLAIM IS A TRUE AND JUST RECORD OF
THAT IT WAS INCURRED IN THE INTEREST OF THE
PERSONAL EXPENSES PAID BY ME WHILE ON OFFICIAL BUSINESS AND FOR WHICH I AM LEGALLY ENTITLED
STATE OF WYOMING AND SAID ACCOUNT IS:
TO REIMBURSEMENT BY THE STATE OF WYOMING. I DO FURTHER CERTIFY THAT NO PART OF THE FOREGOING
CLAIM HAS BEEN PAID BY THE STATE OF WYOMING OR ANY OTHER SOURCE.
APPROVED FOR PAYMENT:
DATE
BY:
(BOARD MEMBER OR DEPARTMENT)
BY:
(BOARD MEMBER OR DEPARTMENT)
SIGNATURE OF CLAIMANT IN INK
DATE
Receipt is required when meal claimed exceeds $15.00, including gratuity
Total daily meals may not exceed $24.00
THIS FORM MUST BE PRINTED IN 3 COPIES, ORIGINAL TO STATE AUDITOR, COPY EACH FOR AGENCY AND EMPLOYEE
REV. 08/03/00
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