Mileage Reimbursement Request Form

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2	Mileage Reimbursement Request Form
3	This form is available as a Google Sheet at www.brssd.org/business-services. Please do the following: (1) open the link, (2) click on "Mileage Reimbursement Request Form," (2) in the Google Sheet menu, click on "File" and then "Make a copy," (3) rename the form for your Drive, (4) complete all sections (totals and amount of check will calculate automatically), (5) print the form, (6) for mileage outside the District, attach a Google Map document showing mileage calculation, (7) attach all emails showing pre-approval, invoices, receipts, and proofs of payment, (8) sign and date, and (9) submit to your Principal or Department Head for review and approval.
4	Please submit your mileage reimbursement request on a timely manner. The District uses the mileage rate released by the IRS.
5	Check payable to:
6	Deliver check to (name of school or address):				Click for BRSSD Mileage Between Schools Grid
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9	Trip Description		Dates:
10	Trip Description							TOTAL
11	From:	To:						-
12	Purpose:
13	From:	To:						-
14	Purpose:
15	From:	To:						-
16	Purpose:
17	From:	To:						-
18	Purpose:
19	From:	To:						-
20	Purpose:
21	From:	To:						-
22	Purpose:
23	From:	To:						-
24	Purpose:
25	From:	To:						-
26	Purpose:
27	TOTAL MILES		-	-	-	-	-	-
28	TOTAL MILES REIMBURSEMENT		2023 rate per IRS (effective 1/1):			0.6550		-
29	Total Parking and/or Tolls (enter $ amount & attach sheets)							-
30	Total Public Trans/Other (enter $ amount)							-
31							Total Due	-
32	Signature of Person Being Reimbursed:					Date:
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34	Account String(s) (SACS 26-digit code) - to be completed by Administrator			Amount
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38			Total
39	Signature of Principal/Department Head:					Date:
40	Note: This form and a copy of the completed requisition should be forwarded to the District Office attn: Budget & Accounting Supervisor for additional review and processing.
41	Budget & Accounting Supervisor Initials: ________
42	Chief Business Official Signature:					Date:
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