ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
2
SPECIAL OLYMPICS ONTARIO - GREATER DURHAM
3
EXPENSE CLAIM FORM
4
5
6
7
First NameLast Name
8
9
Street NumberStreet Name
10
11
CityProvincePostal Code
12
13
14
15
DateReceipt #Activity, Purpose or Event# of KMRate per KM ($0.50)Mileage Amt (Rate x # of KMs)Meals & Accom.SuppliesOther(Please explain)TaxesTotal
16
10.50 - -
17
20.50 - -
18
30.50 - -
19
40.50 - -
20
50.50 - -
21
60.50 - -
22
70.50 - -
23
80.50 - -
24
90.50 - -
25
100.50 - -
26
110.50 - -
27
120.50 - -
28
130.50 - -
29
140.50 - -
30
150.50 - -
31
Total Expense Claim
- - - - - -
32
33
34
35
Date:Signature:
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100