Request for Travel Expense Reimbursement

Request for Travel Expense Reimbursement
Mileage for travel for official business of the Paralegal Division will be reimbursed as follows:
1. Destination must be more than 50 miles one way from member's residence;
2. Actual gas expense will be reimbursed;
3. Driver will be reimbursed at the rate of $1.00 per member passenger attending same meeting/function;
4. Driver will receive an additional 15% of amount of gasoline expense for wear and tear on vehicle (amount due will be automatically calculated).
5. Attach copies of gas receipt(s).
Name *

First Name Last Name
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State

Zip Code
Date Expense Incurred *

Month Day Year
Date
Reason for Travel *
Amount of Gas Receipt *
Additional Passengers *
Total Due
Upload Receipt(s) *

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