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Castle Rock School District #401
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TRAVEL EXPENSE CLAIM
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I HEREBY CERTIFY UNDER PENALTY OF
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PERJURY THAT THIS IS A TRUE AND CORRECT
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CLAIMANT NAME
CLAIMANT SIGNATURE
CLAIM OF NECESSARY EXPENSES INCURRED
DATE
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BY ME AND THAT NO PAYMENT HAS BEEN
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MONTH/YEAR
TITLE
RECEIVED BY ME ON ACCOUNT THEREOF
SUPERVISOR APPROVAL
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 DESTINATION
TIME
SUBSISTENCE
LODGING
AUTOMOBILE @ 0.58
@ $0.76
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 DATE FROM TODEPARTRETURNBLDMILESAMOUNTPURPOSE OF TRIP
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TOTALSTOTAL CLAIM
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ACCOUNT NUMBER
 AMOUNT
DETAIL OF MISCELLANEOUS EXPENSES AND/OR SUPPLIES/MATERIALS
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DATE
VENDOR/PAID TO
MATERIALS/SUPPLIES
AMOUNT
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Meal Reimbursement Rates Vary From County to County
A COPY OF YOUR WORKSHOP/CONF AGENDA MUST BE ATTACHED
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Or copy of an email stating you are requested to attend a meeting or workshop must be attached for backup
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ALL RECEIPTS FOR PURCHASES MUST BE PRINTED AND NUMBERED RECEIPTS
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MEALS FOR DAY TRIPS CANNOT BE CLAIMED FOR REIMBURSEMENT ON THIS FORM UNLESS THE MEAL IS PART OF THE CONFERENCE AND YOU ARE A CAPTIVE AUDIENCE
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How would you like to receive your reimbursement?
District mail
Pick up at District Office
Mailed to address
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