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IN-DISTRICT MILEAGE REIMBURSEMENT FORM
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Auburn School District #408
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Auburn, WA
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Name:School/Dept.
Purchasing
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DateFrom WhereTo WhereReturn (Yes)MilesPurpose
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Rate Per Mile$0.625Total Miles0.0$0.00
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I Hereby certify, under penalty of perjury, that this is a true and correct claim for necessary expense incurred by me and that no payment has been received by me on account thereof.
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Approved
Account Number
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Approved
Signed (Claimant)
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