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1 | Allen County ESC Travel Report | |||||
2 | In order to be reimbursed you MUST turn in your mileage for the months of July, August, September, October, November, and December to your supervisor and superintendent no later than December 31st of the same year. Mileage for the months of January, February, March, April, May, and June MUST be turned into your supervisor and superintendent by June 30th of the same year. | |||||
3 | Name | Program | ||||
4 | Month | Year | Per Mile | $0.55 | ||
5 | Date | From | To | Returned To | Purpose | Actual Miles Traveled |
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42 | Subtotal | 0 | ||||
43 | Rate | $0.55 | ||||
44 | Total Reimbursement | $0.00 | ||||
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46 | Assurance: The above mileage record is true and accurate account of miles actually traveled in the performance of my duties as an employee of the Allen County Educational Service Center. I also certify that I have liability insurance on my vehicle. | |||||
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48 | Signature: | Date: | ||||
49 | Supervisor: | Date: | ||||
50 | Superintendent: | Date: | ||||
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