PAAA Expense Reimbursement Form
Name
*
First Name
Last Name
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
Phone Number
*
Please enter a valid phone number.
Date(s) Incurred:
*
Event/Purpose:
*
Location:
*
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IRS REGULATIONS REQUIRE THAT ORIGINAL RECEIPTS BE ATTACHED FOR ANY EXPENSE ITEMS OF $25.00 OR MORE
Transportation
Plane, train, bus, or taxi/car service
Amount to be reimbursed
Attach image of transportation receipt
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Car Rental
Amount to be reimbursed
Attach image of car rental receipt
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Mileage
@ 72.5c per mile (2026)
Mileage to be reimbursed:
Tolls
Amount to be reimbursed
Attach image of toll receipt
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Lodging
Hotel/Other
Amount to be reimbursed
Attach image of lodging receipt
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Other
Type explanation of other expense(s) incurred
Other
Amount to be reimbursed
Attach image(s) of 'other expense' receipt(s)
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Amount to be reimbursed:
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Signature
These expenses were incurred by me in the fulfillment of my official duties. Personal expenses have been excluded.
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