UAV EXPENSE REIMBURSEMENT FORM

EXPENSE REIMBURSEMENT
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Date Submitted for Reimbursement
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Date of Expense*
Authorization For Expense*

UAV ChairBoard of DirectorsOperating InstructionsOther
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 ProcessInstructor for Regional AVHOF Nominator TrainingOther
If known, what is the budget line item for this expense.*

General AccountAZ Veterans Hall of FameEvent AccountScholarship Account (General)Scholarship, Native AmericanScholarship, VeteranScholarship, Veteran FamilyOther
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.

YESNO
Attach Any Receipts or mail them to UAV Treasurer.

Browse Files
Unified Arizona Veterans, ATTN: Treasurer, P. O. Box 34338, Phoenix, AZ 85067 Cancelof
Signature

Clear
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.
Should be Empty: