2023-24 Expense Reimbursement

2023-24 D6710 Expense Reimbursement Request
This form is to be used for REIMBURSEMENT of expenses incurred on behalf of Rotary District 6710 during the 2023-24 Rotary Year and receipts must be attached. DG Tom Reed has final approval of all expenses and should be consulted PRIOR to large expenditures being incurred. Special situations or large expenditures must be discussed with and approved by DG Tom PRIOR to the expense and the submission of this form.

When completed, this form will automatically be forwarded to DG Tom and District Treasurer Melissa Earnest. Upon approval, Melissa will forward a check to the Rotarian at the address listed below. Please remember that we are all volunteers and allow ample time for processing.

Please note: Incomplete forms or lack of receipts may delay processing.

IRS VOLUNTEER MILEAGE "driven in service of charitable organizations" REIMBURSEMENT RATE IS ".14 cents per mile; the rate is set by statute and remains unchanged from 2022."
DISTRICT TREASURER USAGE ONLY: _______________________________
Rotarian Information
Name of Rotarian*

First NameLast Name
Current position*
Email Address*
Daytime Phone Number*

Area CodePhone Number
Address (Where reimbursement should be sent)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Expenses Incurred for Your Office or Committee

Mileage for personal vehicle and transportation expense (parking/ridshare) are separate sections below.
Date of expense

MonthDayYear
Date
Description of expense

SuppliesPrintingPostageOther
Amount of expense
Charge to Budget Account
Please include a short description if "Other" checked
Date of expense

MonthDayYear
Date
Description of expense

SuppliesPrintingPostageOther
Amount of expense
Charge to Budget Account
Please include a short description if "Other" checked
Date of expense

MonthDayYear
Date
Description of expense

SuppliesPrintingPostageOther
Amount of expense
Charge to Budget Account
Please include a short description if "Other" checked
Date of expense

MonthDayYear
Date
Description of expense

SuppliesPrintingPostageOther
Amount of expense
Charge to Budget Account
Please include a short description if "Other" checked
Date of expense

MonthDayYear
Date
Description of expense

SuppliesPrintingPostageOther
Amount of expense
Charge to Budget Account
Please include a short description if "Other" checked
Total Amount of Expense for this Section
Expenses Incurred for an Event

Mileage for personal vehicle and transportation expense (parking/ridshare) are separate sections below.
Name of Event
Location of Event
Dates of Event
Date of expense

MonthDayYear
Date
Description of expense

LodgingMeals (if not included with registration)RegistrationRoom RentalOther
Amount of expense
Please include short description if "Other" checked.
Date of expense

MonthDayYear
Date
Description of expense

LodgingMeals (if not included with registration)RegistrationRoom RentalOther
Amount of expense
Please include short description if "Other" checked.
Date of expense

MonthDayYear
Date
Description of expense

LodgingMeals (if not included with registration)RegistrationRoom RentalOther
Amount of expense
Please include short description if "Other" checked.
Date of expense

MonthDayYear
Date
Description of expense

LodgingMeals (if not included with registration)RegistrationRoom RentalOther
Amount of expense
Please include short description if "Other" checked.
Total Amount of Expense for this Section
Mileage Reimbursement for Personal Vehicle Usage

Mileage for transportation expense-plane, train, etc. see Transportation Expense Section
Date of expense

MonthDayYear
Date
Description of expense

Round TripOne Way
Purpose of Trip
From Location
To Location
Mileage .14
Amount of Expense
Date of expense

MonthDayYear
Date
Description of expense

Round TripOne Way
Purpose of Trip
From Location
To Location
Mileage .14
Amount of Expense
Date of expense

MonthDayYear
Date
Description of expense

Round TripOne Way
Purpose of Trip
From Location
To Location
Mileage .14
Amount of Expense
Date of expense

MonthDayYear
Date
Description of expense

Round TripOne Way
Purpose of Trip
From Location
To Location
Mileage .14
Amount of Expense
Date of expense

MonthDayYear
Date
Description of expense

Round TripOne Way
Purpose of Trip
From Location
To Location
Mileage .14
Amount of Expense
Date of expense

MonthDayYear
Date
Description of expense

Round TripOne Way
Purpose of Trip
From Location
To Location
Mileage .14
Amount of Expense
Total Amount of Expense for this Section
Transportation Expenses

See previous section for mileage reimbursement for personal automobile usage.
Description of expense

AirfareCab/RideShareCar RentalParkingTollsTrain
Amount of expense
Date of expense

MonthDayYear
DateHourMinutesAM/PM Option
Description of expense

AirfareCab/RideShareCar RentalParkingTollsTrain
Amount of expense
Date of expense

MonthDayYear
DateHourMinutesAM/PM Option
Total Amount of Expense for this Section
Finalize Form
Total Reimbursement Requested

Please insert 0 if you do not have an expense in that section.
Office or Committee Expense*
Total Expense for Event*
Total Transportation Expense*
Total Mileage Expense*
Total Reimbursement Requested*
Comments
Attach Receipts and Supporting Documentation
PDF Scan of Receipts or Uploaded/Saved Registration Forms

Browse Files

Cancelof
PDF Scan of Receipts or Uploaded/Saved Registration Forms

Browse Files

Cancelof
PDF Scan of Receipts or Uploaded/Saved Registration Forms

Browse Files

Cancelof
PDF Scan of Receipts or Uploaded/Saved Registration Forms

Browse Files

Cancelof
PDF Scan of Receipts or Uploaded/Saved Registration Forms

Browse Files

Cancelof
PDF Scan of Receipts or Uploaded/Saved Registration Forms

Browse Files

Cancelof
Checkbox*

Checking this box serves as my signature and verifies that this form was completed following the Four-Way Test.
Should be Empty:

2023-24 D6710 Expense Reimbursement Request

When completed, this form will automatically be forwarded to DG Tom and District Treasurer Melissa Earnest. Upon approval, Melissa will forward a check to the Rotarian at the address listed below. Please remember that we are all volunteers and allow ample time for processing.

Please note: Incomplete forms or lack of receipts may delay processing.

DISTRICT TREASURER USAGE ONLY: _______________________________

Rotarian Information

Expenses Incurred for Your Office or Committee

Expenses Incurred for an Event

Mileage Reimbursement for Personal Vehicle Usage

Transportation Expenses

Finalize Form

Total Reimbursement Requested

Attach Receipts and Supporting Documentation