Local 2068 Expense Reimbursement Form

Expense Reimbursement Form

Complete the expense voucher with your member name and all reimbursable line items. Multiple entries are allowed in each section, and totals will be calculated automatically.
Name

First NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mail or Pickup
Trip Reference / Route ID
Section [I] Lodging, Business Meals, Etc.
Expense Line Items
Total [I]
Section [II] Miscellaneous (Tolls, Parking, Postage, Etc.)
Miscellaneous Expense Line Items
Per Diem - $65 per day
Per Diem Total
Total [II]
Section [III] Travel – Airfare, Fuel, etc. (Mileage @ $0.76/mile)
Travel Line Items
Other Travel
Mileage Reimbursement Rate
Total Reimbursable Mileage Amount
Total [III]
Total [I]
Total [II]
Total [III]
Total Reimbursement Amount
Receipt Upload

Cancelof
Signature
Should be Empty:

Expense Reimbursement Form