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Reimbursement requests must be received in the UNL Accounting Office (401 Canfield) no later than 60 days after the final day on which expenses were incurred.
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THE UNIVERSITY OF NEBRASKA
University Dept. Name:
SAP Document Number:
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EMPLOYEE EXPENSE VOUCHERChemistry
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FOR TRAVEL, MISCELLANEOUS & MOVING REIMBURSEMENTS
Claimant Telephone No.:
Motor Vehicle
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401 Canfield Administration, Lincoln, NE 68588-0439
Circle Type Used:
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Claimant E-Mail:
State
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P
Full Name of Claimant (Employee):
Rental
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A
Personnel Number:
Personal
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Y
Building & Room Number:
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E
Reason For Trip (enter in space below):
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E
Campus or Station:
Campus Zip
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City0304
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Department Contact:
Telephone No. or E-Mail
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List expenses by each day. Refer to the listing of allowable travel expenses on http://travel.unl.edu to determine if a receipt must be
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submitted for each expense. Itemize all miscellaneous expenses. Be sure to enter departure and arrival times for first and last days.
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uDetailed receipts are required for all food/meal expenses equal to or greater than $5. Each request must be fully itemized, including the amount, date, place, and essential character of the expense incurred. This applies to all employees.
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Date
List times for
times forList starting city &MealsLodgingMotor VehicleMiscellaneousTaxi etc.
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first & last day
& last daydestination & ending city$ Amt$ AmtMiles$ AmtDescription$ Amt$ Amt$ TOTAL
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Dep.
0.00 0.00
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Arr.
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Dep.
0.00 0.00
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Arr.
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Dep.
0.00 0.00
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Arr.
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Dep.
0.00 0.00
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Arr.
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Dep.
0.00 0.00
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Arr.
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Dep.
0.00 0.00
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Arr.
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Dep.
0.00 0.00
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Arr.
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Dep.
0.00 0.00
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Arr.
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TOTALS0.000.000.000.00 0.00 0.00 0.00
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I claim reimbursement from the State of Nebraska for the above expenses incurred by me in the line of duty and declare that the above statement of them is a true account of such
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expenses for which payment has not been made heretofore by the State of Nebraska.
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Jody Redepenning, Interim Chair
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Print or Type Name of Supervisor or Approving Official Date
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Print or Type Name of Claimant
Date
Print or Type Title of Supervisor or Approving Official
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Signature of Claimant*
Signature of Supervisor or Approving Official*
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*Must be an original signature. No copies, faxes or stamps are permitted.
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Cost Object
G/L AccountAmount
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Reimbursement Amount $___________
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NOTE AREA
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