School or Center Name:

Account to be Charged:

Name of Meeting, Seminar, etc. Attended:

Is this form submitted by the driver: Yes or No

List passengers if you drove:

3. Air Fare or other Commercial Carrier*

Total Expenses Claimed

NOTE: If registration, airline, etc., was paid by PO or VISA indicate PO#/ Visa charge date on the comment line(no amounts necessary in comments).

I hereby certify that above expenses were actually incurred by me as necessary traveling expenses in the performance of my official duties; attendance at a conference or convention

was directly related to official duties of the agency; any meals or lodging included in a conference or convention registration fee have been deducted from this travel claim; and that this

claim is true and correct in every material matter and same conforms in every respect with the requirements of Section 112.061, Florida Statutes.

Checked at School by

Checked by Finance

Signature of Superintendent/Designee

CCSD 1099 (Rev, 8/93; 10/03; 6/06; 7/08; 1/11; 7/11; 1/13; 8/13; 7/15; 1/16; 1/17; 1/19; 1/20; 1/21; 1/22; 1/23; 1/24: 1/25)