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Employee Expense Reimbursement
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Enter applicable information and charges in cells highlighted in gray.
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Date:
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Name:
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Reason for Reimbursement:
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Travel Date(s):
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Registration Fee (if applicable)
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Round Trip Miles (for personal car only)
x0.42
https://docs.google.com/spreadsheets/d/14gOaPgN0vNApmtyAFiMaol0pzrgQINkY/edit?gid=895742287#gid=895742287
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Rental Car
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Rental Car Fuel
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Tolls
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Parking
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Airfare Fee (include luggage fees)
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Transportaton to/from Airport
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Lodging
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Hotel Bill
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Non-Hotel Lodging
# of Nights
0x$75.00
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*Per Diem - Meal Allowances (no receipts required)
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Half Day(s) - 1 meal# of Daysx$20.00
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Full Day(s) - 2 or 3 meals# of Daysx$60.00
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*Per Diem - Employee + PREauthorized Family Member(s) (no receipts required)
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Full Day(s)# of Days0x$84.00
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Miscellaneous Expense
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CONFERENCE OFFICE USE ONLY
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Special MileageData Item11200
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Per Diem is a taxablePer Deim/Meals TaxableData Item112010.00
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benefit for employeesLodgingData Item112020.00
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if NO overnight stay!Car RentalData Item112030.00
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AirfareData Item112090.00
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Special TrainingData Item11602
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Misc ExpenseData Item11411
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