Expense Request For Payment - Oregon Coast Community College
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1OREGON COAST COMMUNITY COLLEGE
DEPARTMENT:
Expense Request for Payment
PERIOD COVERED:
From:
TO:
Rate: 0.535
Mileage
Meal Reimbursement
Other
Date
Purpose/Explanation
Lodging
Expenses
Account Number
Total
Miles
Amount
Breakfast
Lunch
Dinner
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
SUBTOTALS:
0
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
EMPLOYEE/VENDOR NAME AND ADDRESS (Please print)
EXPENSES BY ACCOUNT
SUBTOTAL:
TOTAL:
LESS ADVANCE:
TOTAL:
TOTAL DUE:
-
TOTAL:
ZIP:
-
TOTAL:
-
I certify that all reimbursements claimed reflect the
Supervisor's Signature:
Date:
actual amount spent and that no part has been
Business Office Signature:
Date:
previously claimed or will be claimed from any other
President's Signature:
Date:
Attach receipts and additional pages, if and as necessary.
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Parent category: Legal