7-7-2013 nancy's Copy of 2013 Expense Reimbursement Form.xls

	A	B	C	D	E	F	G	H	I	J	K	L	M	N
1	TRANSPORTATION DOCUMENT NUMBER		LODGING DOCUMENT NUMBER	STATE OF NEBRASKA								BATCH NUMBER	DOCUMENT NUMBER
2				EXPENSE REIMBURSEMENT REQUEST
3	DATE	NAME OF PLACE AND NATURE OF SERVICE		TRAVEL TIMES		MEALS		LODGING	TRANSPORTATION			MISCELLANEOUS
4	201_	Enter start and stop points for each trip				Actual Amounts only		DB1, DB2, etc., if direct billed		MILES TRAVELED
5	month/day	State purpose of each trip		STARTED	STOPPED	Actual Amounts only		DB1, DB2, etc., if direct billed	RATE	MILES TRAVELED	AMOUNT	DESCRIPTION	AMOUNT	TOTAL
7	7/1	National Federation of the Blind Convention				B	9.80		0.565		-	Red's Deli		9.80
8		Rosen Centre, Orlando FL				L	5.75		0.565		-	Habana Grill		5.75
9						D	24.00	44.88	0.565		-	Lobby Bar		68.88
10	7/2	National Federation of the Blind Convention				B	9.55		0.565		-	Elegante Market		9.55
11		Rosen Centre, Orlando FL				L	13.00		0.565		-	Taste of Asia		13.00
12						D	17.00	44.88	0.565		-	Denny's		61.88
13	7/3	National Federation of the Blind Convention				B			0.565		-			-
14		Rosen Centre, Orlando FL				L	6.66		0.565		-	Smoooth Java		6.66
15						D	7.40	44.88	0.565		-	Red's Deli		52.28
16	7/4	National Federation of the Blind Convention				B	4.79		0.565		-	Red's Deli		4.79
17		Rosen Centre, Orlando FL				L	10.76		0.565		-	Red's Deli		10.76
18						D		44.88	0.565		-			44.88
19	7/5	National Federation of the Blind Convention				B	10.86		0.565		-	Red's Deli		10.86
20		Rosen Centre, Orlando FL				L			0.565		-			-
21						D	32.93	44.88	0.565		-	Café Gauguin		77.81
22	7/6	National Federation of the Blind Convention				B	16.12		0.565		-	Café Gauguin		16.12
23		Rosen Centre, Orlando FL				L	20.00		0.565		-	Red Lobster		20.00
24						D		44.88	0.565		-			44.88
25	7/7	National Federation of the Blind Convention				B			0.565		15.00	Super Shuttle		15.00
26		Rosen Centre, Orlando FL			1:00 PM	L			0.565		-			-
27						D			0.565		-			-
28						B			0.565		-			-
29						L			0.565		-			-
30						D			0.565		-			-
31						B			0.565		-			-
32						L			0.565		-			-
33						D			0.565		-			-
34	DB: 1				TOTALS		188.62	269.28		-	15.00		-	472.90
35	DB: 2								Business Unit			Object Code	Amount
36	DB: 3
37	DB: 4
38	DB: 5
39
40
41	NAME and TITLE			ADDRESS BOOK NUMBER			HEADQUARTER CITY
42	Nancy L. Coffman, Program Specialist/Technology Services			126528			Lincoln		SUPERVISOR or APPROVER SIGNATURE				DATE
43	ADDRESS			CITY			STATE	ZIP CODE
44	880 S. 39th St.			Lincoln			NE	68510
45	I claim reimbursement for the above expenses incurred by me in the line of duty and in accordance with Nebraska State Statutes. I declare that this is a true account of such expenses for which payment has not previously been made by the State of Nebraska or another source.								I certify that reimbursement for use of privately owned vehicles is authorized according to the provisions of NE State Statutes sections 81-1014 & 81-1176.				Veh. Lic.#
46	EMPLOYEE SIGNATURE						DATE		AUTHORIZED SIGNATURE				DATE
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