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Faculty Removal Worksheet
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Employee Name
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Department
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IRS Time & Distance Requirements
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Distance Requirement
Yes No
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Is the employee's new principal place of work at least 50 miles farther from the employee's old residence than was the employee's former principal place of work?
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Time Requirement
Yes No
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Is it anticipated that the employee will work full-time for at least 39 weeks during the 12-month period immediately following the employee's start date?
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Commencement of Work Requirement
Yes No
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Were the employee's moving expenses incurred within one year from their start date?
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Members of household included in the move:
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NameRelationship
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Acknowledgment
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I have read the Faculty Removal Packet and understand that:
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my total removal allocation is
$10,000
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prior approval must be requested for a staged move or a move from multiple locations
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receipts must be turned in for processing within 60 days of the completion of my move
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reimbursement is based on actual costs, not per diem limits
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all reimbursements paid to me, or payments made on my behalf, for moving expenses are considered taxable income. I will receive reimbursement for out-of-pocket expenses and understand that future paycheck(s) will be reduced by the amount of additional payroll tax witholding.
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SignatureDate
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