EXPENSE REIMBURSEMENT
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Date Submitted for Reimbursement
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Date of Expense
*
Authorization For Expense
*
UAV Chair
Board of Directors
Operating Instructions
Other
What is the reason for this expense?
*
Purchase General Administrative Supplies (see next question)
Purchase Supplies or Equipment for UAV Programs (see next question)
Participate in AVHOF Selection Process
Instructor for Regional AVHOF Nominator Training
Other
If known, what is the budget line item for this expense.
*
General Account
AZ Veterans Hall of Fame
Event Account
Scholarship Account (General)
Scholarship, Native American
Scholarship, Veteran
Scholarship, Veteran Family
Other
MILEAGE, if claimed. If mileage is claimed, fill in the following. Mileage will normally be calculated from city to city, not street to street. UAV will reimburse round trips of 100 miles or more at $0.25 per mile.
Indicate the city travelled to. Also, if "Other" was selected for Reason For Travel, please clarify.
If items were purchased or other expenses incurred, please list and attach copies of the receipts as required below.
If an OVERNIGHT STAY is claimed, click YES and submit a receipt as required below. UAV will reimburse you up to $100 per night.
YES
NO
Attach Any Receipts or mail them to UAV Treasurer.
Browse Files
Unified Arizona Veterans, ATTN: Treasurer, P. O. Box 34338, Phoenix, AZ 85067
Cancel
of
Signature
If you cannot use the touchscreen signature feature above, please type in your name below signifying that the information that you are submitting is correct.
Submit
Should be Empty: