Vietnam Veterans of America      Quad Cities Chapter 299

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Expense Form

Check Number____________ & Date:______________
VIETNAM VETERANS OF AMERICA – CHAPTER 299 – EXPENSE/REIMBURSEMENT VOUCHER
NAME:   ____________________________________________________
ADDRESS:   _________________________________________________________
CITY/STATE/ZIP:   _____________________________________________
PHONE:   __________________ E-MAIL ADDRESS_____________________________________________
**PURPOSE OF EXPENSE: ________________________________________________________________
PERDIEM: $50.00 PER DAY_______N/A___________________________
(FIRST & LAST TRAVEL DAY 3/4 PD)
DATES OF TRAVEL FROM:_______/_________/________
TO:_______/___________/__________
LODGING (ATTACH RECEIPTS):___________________________________________________
GAS RECEIPTS (ATTACH):________________________________________________________
MISCELANIOUS /OTHER (ATTACH RECEIPTS):________________________________________
EXPLAINATION________________________________________________________________
TOTAL AMOUNT CLAIMED: $ ____________________________________________________
_____________________________________________________________________________________
OTHER EXPENSES, NON TRAVEL RELATED, THAT ARE REQUESTED FOR REIMBURSEMENT.
**REFERENCE:  PURPOSE OF EXPENSE, ABOVE
Date of Expense: 9/1/13 thru 2/10/14      Committee or Budget to be charged: ____________________
 
Item/Purpose:                                                                                                       $AMOUNT  $_______
 
Item/Purpose:                                                                                                                              $AMOUNT  $_________
Item/Purpose:                                                                                                                                  $AMOUNT: _________
Item/Purpose:                                                                                                                                  $AMOUNT   $_______
TOTAL                                                                                                                                              $ ________________
SIGN:                                                                                                       Date
IF total request is in over $100.,  please submit through your committee Chairman and have initialed
Committee Chair____________________________________________        Date________________
Please attach all receipts, supporting documents and additional information needed.
This document is provided to supply supporting documentation in the event of any audit, for both the Chapter and our members. The more detail the better. THANK YOU!
                                                                                                            Form: Exp. Revised 2/1/14
 
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