ABCDEFGHIJKLMNOPQRSTUVWXYZAA
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DEKALB COUNTY BOARD OF EDUCATION
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STATEMENT OF OFFICIAL TRAVEL OR PROFESSIONAL DEVELOPMENT REIMBURSEMENT CLAIM
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FOR OFICE USE ONLY
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Pay from______________________ Fund
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Vendor No. ______________________________________________
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Official Station or Base
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PROFESSIONAL DEVELOPMENTApprop. Acct. ______________________________________________
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YES NO
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NAME Date Paid ______________________________________________
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ADDRESS
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CITY, STATE, ZIP
Check No. ______________________________________________
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NAME & ADDRESS OF EMPLOYEE CLAIMING REIMBURSEMENT
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POINTS OF TRAVEL
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DATEPURPOSE OF VISITFROMTOCar MilesBrkfLunDinRoomTotal
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#N/A$0.00
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#N/A$0.00
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#N/A$0.00
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#N/A$0.00
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#N/A$0.00
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#N/A$0.00
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#N/A$0.00
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#N/A$0.00
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#N/A$0.00
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#N/A$0.00
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#N/A$0.00
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#N/A$0.00
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#N/A$0.00
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#N/A$0.00
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Total Room & Meals$0.00
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Total Car miles @ $.67#N/A#N/A
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Miscellaneous Expense - Attach Receipt
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I HEREBY CERTIFY THAT THE TRAVEL AND EXPENSES INDICATED HEREON WAS ACCOMPLISHED IN THE PERFORMANCE OF OFFICIAL DUTIES PURSUANT TO THE TRAVEL GRANTED ME.TOTAL AMOUNT CLAIMED#N/A
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SIGNATURE OF TRAVELER
SUPERINTENDENT'S APPROVAL
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ALL ROOM AND MEAL RECEIPTS MUST BE ATTACHED TO FORM.
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REVISED 01/01/11 FORM DCBE-001 REV B
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