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Name of Claimant:Purpose of Claim:
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Home Address Including Postal Code:Date of Claim:
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Does this claim include an ATA conference?YesNo
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Was a subsitute required?YesNo
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Date: (Year/Month/Day)Description: Please provide full details and committeekmsBudget Line or Committee (Treasurer use only)Receipt Amount - No mileage
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Line ATotal km claimed:0at 69¢/km =$0.00
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Line BTotal Other Expenses =$0.00
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Line CTotal =$0.00
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Cheque #Amount:
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1. Please attach all receipts. Claims without receipts will not be paid. Claims must be submitted within 3 months of the activity.
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2. Mileage will be paid for all Local business trips excluding general meetings. Mileage is paid from place of residence to the
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meeting place, or from school to the meeting place, whichever is the lesser. The full mileage may be claimed.
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3. Rates payable. Mileage 67¢/km. Meals: breakfast max. $30, lunch max. $30, & supper max. $40. No alcohol.
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4. This form is to replace the old form & these guidelines will be followed for all claims from Feb 1, 2025 until further notice.
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5. By signing claim form you acknowledge that monies received may be published for accountability purposes.
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Signature of Claimant: ______________________________________________
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