Effective Rate 1-1-23.xlsx

	A	B	C	D	E	F	G	H	I
1						TRAVEL REIMBURSEMENT		TYPE NAME:
2
3								SIGNATURE:
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5								PERIOD OF:
6		LOCATION		MAP	VICINITY	TOTAL	PURPOSE	Program /	Accounting
7	DATE	FROM	TO	MILES	MILES	MILES	(Please give explanation)	Client	Use
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31					Sub-total miles this page	0
32					Miles from page 2	0
33					Miles from page 3	0
34	PLEASE DO NOT WRITE BELOW THIS LINE.				TOTAL MILES	0	Total Miles X $ 0.655 = Total mileage reimbursement	$ -
35			Mileage Reimbursement:	$_______________
36			Per Diem	$_______________			__________________________	Reimbursed:	$
37			Lodging	$_______________			Signature of Approving Official
38			Other	$_______________			__________________________	Date of Check:
39			Less Advance Travel:	-$_______________			Verification of Figures By
40			Total to be Reimbursed:	$				Check Number:
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