Form A&i-25 - Travel Request

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STATE OF WYOMING
A&I-25 Rev. 4/00
Travel Request
(Date)
Fund
Org
(Division)
BFY
Agcy
Appr
Project #
(Agency)
to
Permission is hereby requested for
(Name and Title)
from
to
travel by (mode - private or commercial)
Departure
Return
Purpose of Trip
Remarks
Interrupted Travel: Yes
No
Authority Requested by:
OUT-OF-STATE
Previous Out-of-State Travel
Estimated Airfare
Estimated Other Transportation
Estimated Meals & Lodging
Registration Fee
Estimated Other
ESTIMATED TOTAL COST
DISAPPROVED
APPROVED
Actual
Per Diem
($70.00)
(Administrator/Supervisor)
APPROVED
DISAPPROVED
(Director)
IN-STATE
Estimated Transportation Costs
APPROVED
DISAPPROVED
Estimated Meals & Lodging
(Administrator)
Estimated Fees
APPROVED
DISAPPROVED
Estimated Other
ESTIMATED TOTAL COST
(Director)
APPROVED
DISAPPROVED
Actual
Per Diem
($60.00)
(Governor/Designee)
NOTE: Submit In quadruplicate at least 15 days prior to date of In-state trips and 7 days for out -of state. Original approved
request must be submitted with travel voucher for payment

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