Form Mo 300-1189 - Monthly Expense Report - 2011
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1STATE OF MISSOURI
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MONTHLY EXPENSE REPORT
FOR MONTH OF
PAGE ______ OF ______
THE WHITE AREAS MUST BE COMPLETED. THE GRAY AREAS ARE OPTIONAL
DEPARTMENT/DIVISION OR INSTITUTION
FOR AGENCY USE. SEE INSTRUCTIONS ON BACK.
EMPLOYEE NAME (LAST, FIRST)
VENDOR CODE (SOCIAL SECURITY NUMBER)
OFFICE ADDRESS
WORK PHONE NO.
UNIT/COUNTY
LOCATION CODE OR DOCUMENT NO.
OVER-
RET STANDARD
FLEET
BREAK-
DATE
FROM/TO & PURPOSE
NIGHT
LUNCH
DINNER
LODGING
OTHER*
TOTAL
(X)
MILES
MILES
FAST
STAY (X)
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
0.00
0.00
0.00
TOTALS OF ABOVE
TOTALS FROM OTHER PAGES
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
TOTAL STANDARD MILES
AT
¢ PER MILE
0.00
0.370
0.00
TOTAL FLEET MILES
AT
¢ PER MILE
0.260
0.00
TOTAL INSTATE
T
OTAL OUTSTATE
0.00
TOTAL REIMBURSABLE EXPENSE
$
$
0.00
DATE
*EXPLANATION OF OTHER
I hereby certify the above claim is correct, that these expenses were necessary to conduct state business, that payment has been made from
personal funds for which I have not been reimbursed,
nor
will I receive from any source any payment for these expenses.
APPROVAL SIGNATURE
CLAIMANT SIGNATURE
DATE
TITLE
DATE APPROVED
TITLE
OFFICIAL DOMICILE
FUND
AGCY
ORG/SUB
APPR UNIT
ACTIVITY
FUNCTION
OBJ/SUB
JOB NUMBER
REP CAT
AMOUNT
VERIFIED BY AND DATE
/
/
/
/
/
/
CODED BY AND DATE
/
/
/
/
/
/
CK CATEGORY
/
/
/
/
MO 300-1189 (1-11)
SAM II
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Parent category: Business