Mileage Claim Form .xlsx

	A	B	C	D	E	F	H	I	J
1	MILEAGE CLAIM
2
3	South Dearborn Community School Corporation					TO:
4	(Governmental Unit)
5						ON ACCOUNT OF APPROPRIATIONS NO. __________ FOR ______________
6
7	(Office, Board, Department or Institution)
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10	DATE	FROM	TO	ODOMETER READING		NATURE OF BUSINESS		AUTO MILES	MILEAGE @ $.76 PER MILE
11		POINT	POINT	START	FINISH	NATURE OF BUSINESS		TRAVELED	MILEAGE @ $.76 PER MILE
12									$0.00
13									$0.00
14									$0.00
15									$0.00
16									$0.00
17									$0.00
18									$0.00
19									$0.00
20									$0.00
21									$0.00
22									$0.00
23									$0.00
24									$0.00
25									$0.00
26									$0.00
27									$0.00
28									$0.00
29									$0.00
30									$0.00
31									$0.00
32									$0.00
33									$0.00
34									$0.00
35									$0.00
36									$0.00
37									$0.00
38	AUTO LICENSE NO.						TOTALS	0	$0.00
39
40	+ ODOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
41	Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just credits, and that no part of the same has been paid.
42	Date:				Signature:
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