TRAVEL EXPENSE FORM.xlsx

	A	B	C	D	E	F	G	H	I
1
2	BROOKE COUNTY BOARD OF EDUCATION						TRAVEL EXPENSE STATEMENT
3
4	NAME:			ADDRESS:
5
6	MONTH OF:
7
8	ID #			VENDOR NUMBER:
9	PURPOSE
10	OF TRAVEL			SUPERVISOR'S APPROVAL
11				current Federal Rate
12	DATE	FROM TO	MILEAGE	AMOUNT	LODGING		MEALS		TOTAL
13					& OTHER	BRK.	LUNCH	DNR
14				#VALUE!					#VALUE!
15				0.00					0.00
16				0.00					0.00
17				0.00					0.00
18				0.00					0.00
19				0.00					0.00
20				0.00					0.00
21				0.00					0.00
22				0.00					0.00
23				0.00					0.00
24				0.00					0.00
25				0.00					0.00
26				0.00					0.00
27				0.00					0.00
28				0.00					0.00
29				0.00					0.00
30				0.00					0.00
31				0.00					0.00
32				0.00					0.00
33				0.00					0.00
34				0.00					0.00
35				0.00					0.00
36				0.00					0.00
37				0.00					0.00
38				0.00					0.00
39				0.00					0.00
40		TOTAL		#VALUE!	0.00	0.00	0.00	0.00	#VALUE!
42	STATE OF WEST VIRGINIA, COUNTY OF BROOKE, to-wit:
43	I, the undersigned, do solemnly swear that the above expense account is just, accurate and true and is claimed for cash expended for the purpose named in this statement.
44			Signature of employee:
45
46	Taken, subscribed and sworn to before me this				day of			year
47	My commission expires:			Notary Public
48
49	x
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