Reimbursement Form
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CESA 8 Reimbursement Form
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223 W Park Street, Gillett, WI 54124
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Submit this form promptly each month.
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NAME:DATE:
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DateFromToOdom BeginOdom EndingTotal Miles**-NonTotal Meals*Lodging, Misc.Met WithProject #
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AllowedPd Miles#AmtReason
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0
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(No. of Miles)
x Rate:0.540=$0.00$0.00$0.00$0.00
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TOTAL
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Receipts and prior approval must be attached and the claim must be submitted within 60 days of the expenditure. Due by the 15th of each month to assure timely Board approval.
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*Meal reimbursement contingent upon overnight travel or the meal was directly related to a CESA 8 business event in a clear business setting, business was actively conducted and the business was directly related to your profession.
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**Not every employee uses this column. If you haven't been told to do this, just skip over this column completely.
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Signature of Reimbursed Person:
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My signature certifies the above claim is true and accurate.
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Mailing Address:
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CESA 8 Office Use Only
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Vendor #:
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Project Director
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Code:
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Checked By:
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CESA 8 Administrator
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