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i <br /> ORANGE COUNTY ABC BOARD <br /> TRAVEL REIMBURSEMENT REQUEST AND EXPENSE REPORT* j <br /> REQUEST/REPORT SECTION <br /> Name of Requestor: Jennifer Title: manager Date of Request: <br /> Im ortant-attach all applicable receipts and/or invoices to this report <br /> Sun Mon Tues Wed Thurs Fri Sat Totals <br /> Dates Traveled == <br /> - — I <br /> Lodging (ind taxes) $ <br /> Fares,Air, Bus, etc <br /> To/From Destination <br /> Mileage-personal <br /> vehicle (per below) <br /> Meals: Breakfast <br /> Incl. Lunch <br /> Tips Dinner <br /> Flat Rate <br /> Taxi, Bus, Rental <br /> I <br /> Registration Fees <br /> Conference Ex <br /> Telephone <br /> Baggage Handling <br /> Other Expenses <br /> Totals <br /> Comments: <br /> Explanation of personal vehicle expenses: <br /> Mileage ; <br /> Date From (location) To location Claimed $Amount <br /> carrboro first horrizon <br /> i <br /> EXPENSE SUMMARY <br /> Total cost of trip per above <br /> Less: expenses prepaid by Board <br /> Less: cash advanced <br /> Add (Deduct) other adjustments - Explain j <br /> Balance Due- Board or Requestor(Circle One) <br /> I hereby certify that the foregoing travel expenses were incurred in the conduct of Board business. <br /> Signature of requestor: Date: <br /> APPROVAL/REVIEW/PAYMENT SECTION <br /> i <br /> Approved by Board Chair: Date: <br /> Reviewed & approved for payment by GM: Date: <br /> A completed Travel Reimbursement and Expense Report form should be submitted within 14 work days j <br /> after returning from travel (OCABC Board Policy & Procedure Manual). <br /> OCABC Board Form 002, October 21, 2003 (Prior forms are superseded) <br /> Article III,Appendix B -OCABC Board Form 002 -Travel Reimbursement Request <br /> 11I-7 <br />