Form A-14a - Out-Of-State Travel Expense Report

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A-14A
1/10
0.50
OFFICE OF ACCOUNTS AND CONTROL
OUT-OF-STATE TRAVEL EXPENSE REPORT
Employee Name
SSN
Title
Department
Division
Period Covered
Start Date
Time
End Date
Time
Purpose of Trave
DESCRIPTION OF CHARGES
REQUIRED DOCUMENTATION
Transportation Charges (excluding aut
$
Included
Not Applicable
Hotel (Reimbursable)
$
Car Rental
$
Travel Itinerary(s)
Taxi/Shuttle/Parking/Tolls
$
Ticket(s) or Ticketless Itinerary(s)
$
Hotel Detail Bill
Misc
$
Agenda
$
Car Rental Receipt
Copy of A-47
$
Taxi/Shuttle
LESS PREPAYMENT
$
Parking/Tolls
LESS CREDIT DUE STATE
$
$
$0.00
Miscellaneous
SUBTOTAL
#
MEALS:
Per Diem #
X $ 30.00
$
0.00
Half Day
X $ 15.00
$
0.00
Note: Attach explanation for any missing documentation or
justification for extra night's stay.
$
$0.00
SUBTOTAL
$0.00
TOTAL
COMMENTS
Model
Year
Registration
IF MILEAGE CLAIMED Vehicle(s) Make
Auto Insurance Carrier
Auto Policy Expiration Date
ODOMETER READING
ALLOWANCE
DATE
FROM
TO
START
FINISH
MILES (rounded)
0
0
0
0
0
$
-
0.50
(rate)
$0.00
PLUS TOTAL REIMBURSEMENT
$
-
TOTAL DUE TRAVELER
ACCOUNT #
NAT ACCT#
AMOUNT
ACCOUNT #
NAT ACCT#
AMOUNT
I hereby certify that this travel expense complies with the state travel
I hereby certify that throughout the above dates I have maintained a valid operator's
regulations and that the total listed above is a proper charge against the
license and my vehicle(s) has been properly registered and insured; that the above
state.
mileage is correct and was incurred for official state business. The travel from my
residence was shorter than the travel between my official station and the destination;
that this travel expense complies with the state travel regulations.
Signature of Traveler
Signature of Supervisor/Authorized Agent

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