Council Mileage Report
Use this form to request a check to be written from the District NYI account SPECIFICALLY for mileage.
Who is requesting this check? (Council Member)
*
First Name
Last Name
Email
example@example.com
Who should the check be made to?
*
What is the date of the council meeting?
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How many miles away from the meeting place is your home? (One-way)
*
Total amount of travel reimbursement:
2(One-way miles) * $0.655 = total reimbursement
Date Submitted
-
Year
-
Month
Day
4 digit year, 2 digit month, 2 digit day
Date
Submit
Should be Empty: