Spreadsheet: 21e1829f-b453-4a2c-8498-d47790184068
Sheet: Travel Form

NORTH CAROLINA CENTRAL UNIVERSITY
Request For Reimbursement Of Travel And Other Expenses
Incurred In The Discharge Of Official Duty - Including Per Diem
INSTRUCTIONS TO CLAIMANT:  Prepare two (2) copies.  Attach all necessary receipts and other supporting documents
to this form and submit the original and one (1) copy to the Travel Office.
Payee's Name |  |  |  |  |  |  |  |  | Banner ID |  |  |  |  | Date of this Request
Payee's Address |  |  |  |  |  |  |  |  | Period Covered by this [NAME] (from/to, date and time left and returned)
Department |  |  |  |  |  |  |  |  | Title |  |  |  |  |  |  |  | [NAME]
Account Number |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Controller's
 |  |  |  | IN STATE |  | OUT OF STATE |  |  |  |  |  |  |  | Amount |  |  | use only
Air Transportation |  |  |  |  |  |  |  |  | Total Expense |  |  |  |  |  |  |  | $
Ground Transportation |  |  |  |  |  |  |  |  | Deduct:  Advance |  |  |  |  | 0
Hotel |  |  |  |  |  |  |  |  | Deduct: |  |  |  |  | 0
Meals |  |  |  |  |  |  |  |  | Amount Due [NAME]
Other Travel Expense |  |  |  |  |  |  |  |  | Amount Due Claimant
Registration
Total Expense |  |  |  |  |  |  |  |  | Amount subject to Federal and
 |  |  |  |  |  |  |  |  | State Income Tax Law
Under penalties of perjury, I certify this is a true and accurate |  |  |  |  |  |  |  |  | I have examined this reimbursement request and certify
statement of the lodging expenses and allowances incurred in |  |  |  |  |  |  |  |  | that it is just and reasonable.
the service of the State.
(Claimant) |  |  |  |  |  |  |  |  | (Supervisor) |  |  |  |  |  |  | [NAME]
Date | Registration |  |  |  |  |  | In-State |  | Out-of-State
Total
 | Travel (show each city visited) |  |  |  |  | Transportation |  |  |  |  |  | Subsistence |  |  |  | Other Expenses
Date | From/To: |  |  |  |  |  | In-State |  | Out-of-State |  |  |  | In-State | Out-of-State |  | I/O | Explain | Amount
 |  |  |  |  |  | R |  |  |  |  |  | B |  | 0
 |  |  |  |  |  | A |  |  | 0 |  |  | L |  | 0
 |  |  |  |  |  | O |  |  |  |  |  | D |  | 0
 | Departed |  |  |  |  | P |  |  |  |  |  | H |  | 0
Daily Priv Car Mileage |  |  | 0 |  |  |  |  |  |  |  |  | Total
Daily Priv Car Mileage
 |  |  |  |  |  | R |  |  |  |  |  | B |  | 0 |  |  |  | 0
 |  |  |  |  |  | A |  |  |  |  |  | L |  | 0
 |  |  |  |  |  | O |  |  |  |  |  | D |  | 0
 |  |  |  |  |  | P |  |  |  |  |  | H |  | 0
Daily Priv Car Mileage |  |  |  |  |  |  |  |  |  |  |  | Total
Daily Priv Car Mileage |  |  |  |  |  |  |  |  |  |  |  |  | Total | Total |  |  |  | Sutotal
Mode of Travel |  |  | Type of Subsistence |  |  |  | Total |  | Total |  |  |  | Authorized | Authorized |  |  |  | Other
P=Private Car |  |  |  | In-State   Out-of-State |  |  | Transport |  | Transport |  |  |  | Subsistence | Subsistence |  |  |  | Expenses
A=Air |  |  | Breakfast
O=Other - Bus |  |  | Lunch |  |  |  |  |  |  |  |  |  |  |  |  |  | In-State:
R=Rental |  |  | Dinner |  |  |  |  |  |  |  |  |  |  |  |  |  | Out-of-State:
 | Travel (show each city visited) |  |  |  |  | Transportation |  |  |  |  |  | Subsistence |  |  |  | Other Expenses
Date | From/To: |  |  |  |  |  | In-State |  | Out-of-State |  |  |  | In-State | Out-of-State
 | Totals brought forward |  |  |  |  |  |  |  |  |  |  |  |  |  |  | I/O | Explain | Amount
 |  |  |  |  |  | R |  |  |  |  |  | B |  | 0 |  |  |  | 0
 |  |  |  |  |  | A |  |  |  |  |  | L |  | 0
 |  |  |  |  |  | O |  |  |  |  |  | D |  | 0
 |  |  |  |  |  | P |  |  |  |  |  | H |  | 0
Daily Priv Car Mileage |  |  |  |  |  |  |  |  |  |  |  | Total
Daily Priv Car Mileage
 |  |  |  |  |  | R |  |  |  |  |  | B |  | 0
 |  |  |  |  |  | A |  |  |  |  |  | L |  | 0
 |  |  |  |  |  | O |  |  |  |  |  | D |  | 0
 |  |  |  |  |  | P |  |  |  |  |  | H
Daily Priv Car Mileage |  |  |  |  |  |  |  |  |  |  |  | Total
Daily Priv Car Mileage
 |  |  |  |  |  | R |  |  |  |  |  | B
 |  |  |  |  |  | A |  |  |  |  |  | L
 |  |  |  |  |  | O |  |  |  |  |  | D
 |  |  |  |  |  | P |  |  |  |  |  | H
Daily Priv Car Mileage |  |  |  |  |  |  |  |  |  |  |  | Total
Daily Priv Car Mileage
 |  |  |  |  |  | R |  |  |  |  |  | B
 |  |  |  |  |  | A |  |  |  |  |  | L
 |  |  |  |  |  | O |  |  | 0 |  |  | D | 0
 |  |  |  |  |  | P |  |  |  |  |  | H
Daily Priv Car Mileage |  |  |  |  |  |  |  |  |  |  |  | Total
Daily Priv Car Mileage |  |  | 0
 |  |  |  |  |  | R |  |  |  |  |  | B |  |  |  |  |  | 0
 |  |  |  |  |  | A |  |  |  |  |  | L
 |  |  |  |  |  | O |  |  |  |  |  | D
 |  |  |  |  |  | P |  |  |  |  |  | H
Daily Priv Car Mileage |  |  |  |  |  |  |  |  |  |  |  | Total
Daily Priv Car Mileage
 |  |  |  |  |  | R |  |  |  |  |  | B
 |  |  |  |  |  | A |  |  |  |  |  | L
 |  |  |  |  |  | O |  |  | 0 |  |  | D
 |  |  |  |  |  | P |  |  |  |  |  | H
Daily Priv Car Mileage |  |  |  |  |  |  |  |  |  |  |  | Total
Daily Priv Car Mileage
 |  |  |  |  |  | R |  |  |  |  |  | B |  |  |  |  |  | 0
 |  |  |  |  |  | A |  |  |  |  |  | L
 |  |  |  |  |  | O |  |  | 0 |  |  | D |  | 0
 |  |  |  |  |  | P |  |  |  |  |  | H |  | 0
Daily Priv Car Mileage |  |  |  |  |  |  |  |  |  |  |  | Total
Daily Priv Car Mileage
 |  |  |  |  |  | R |  |  |  |  |  | B |  | 0 |  |  |  | 0
 |  |  |  |  |  | A |  |  |  |  |  | L |  | 0
 |  |  |  |  |  | O |  |  | 0 |  |  | D |  | 0
 |  |  |  |  |  | P |  |  |  |  |  | H |  | 0
Daily Priv Car Mileage |  |  |  |  |  |  |  |  |  |  |  | Total
Daily Priv Car Mileage
 |  |  |  |  |  | R |  |  |  |  |  | B |  | 0
 |  |  |  |  |  | A |  |  |  |  |  | L |  | 0
 |  |  |  |  |  | O |  |  |  |  |  | D |  | 0
 |  |  |  |  |  | P |  |  |  |  |  | H
Daily Priv Car Mileage |  |  |  |  |  |  |  |  |  |  |  | Total
Daily Priv Car Mileage |  |  |  |  |  |  |  |  |  |  |  |  | Total | Total |  |  |  | Sutotal
 |  |  | Total |  |  |  | Total |  | Total |  |  |  | Authorized | Authorized |  |  |  | Other
 |  |  | Registration |  |  |  | Transport |  | Transport |  |  |  | Subsistence | Subsistence |  |  |  | Expenses
 |  | In-State: |  |  |  | Ground |  |  |  |  |  | Meals |  |  |  |  | In-State:
 |  | Out-of-State: |  |  |  | Air |  |  |  |  |  | Hotel |  |  |  |  | Out-of-State:
 |  | Total: |  |  |  | Total |  |  |  |  |  | Total |  |  |  |  | Total: