Spreadsheet: 266793e6-5f7e-4214-ad21-f3bea451d42f
Sheet: Sheet1

OSF FORM 19 | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Acct # | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | CLAIM OF: | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17
(Revised Jan, 2012) |  |  |  |  |  |  |  |  |  |  |  | SS# (Last four digits or ID#)
STATE OF OKLAHOMA |  |  |  | Fund |  |  | Agency |  |  | Claim |  | Address:
Travel Voucher |  |  |  |  |  |  | 665
 |  |  |  | IN-STATE |  |  |  | OUT-OF-STATE |  |  |  |  |  | FOR
 | IS CAR GOV. OWNED? |  |  | OBJECT ACCT |  | AMOUNT |  | OBJECT ACCT |  | AMOUNT |  |  |  | 0
 |  |  |  | 521110 Mileage |  |  |  | 521210 Mileage
 | YES |  |  | 521120 Per Diem |  |  |  | 521220 Transp |  |  |  |  |  | AGAINST
 | NO |  |  | 521130 Public Trans |  |  |  | 521230 Per Diem |  |  |  | Agency, Bd.,
 |  |  |  | 521140 [NAME] |  |  |  | 521240 Local Trans |  |  |  | Comm., Dept.
 | LICENSE NO.: |  |  | 521150 Lodging |  |  |  | 521250 [NAME]. |  |  |  | ASSIGNMENT
 |  |  |  |  |  |  |  | 521260 Lodging |  |  |  | I hereby assign this claim to
IS CLAIMANT A STATE OFFICIAL OR EMPLOYEE? |  |  |  | NON-EMPLOYEE
 |  |  |  | 521310 All Travel |  |  |  |  |  |  |  | and authorize the State Treasurer to issue a warrant in payment to said assignee.
 | YES
 | NO |  |  | Sub-Total |  | 0 |  | Sub-Total |  | 0
 |  |  |  |  |  |  |  | Total Amount |  | 0 |  | Claimant Signature
OFFICIAL DUTY STATION: |  |  |  | NATURE OF OFFICIAL BUSINESS:
 |  |  |  |  |  |  |  |  |  |  |  | Date
Show point travel status began, each point visited and the point travel status ended.  (Vicinity only travel should show general geographical area, e.g., Tulsa Vicinity) |  |  |  |  | Date |  | Mileage |  | Travel Status |  | Number |  | Per-Diem |  | Lodging |  | TOTAL     PER DIEM / LODGING
 |  |  |  |  | FY |  | Claimed |  | Hour |  | of
 |  |  |  |  | Mo. | Day | [NAME] | Vicinity | Entered | Ended | Days | Hrs | Rate | Amount | Amount
TOTALS |  |  |  |  |  |  | 0 | 0 | To Calculate - Press F9 |  |  |  |  | 0 | 0 |  | 0
 |  |  |  |  |  |  | 0 |  | TOTAL MILES @ |  |  |  | 0.565 | Per Mile = |  |  | 0
MODE OF PUBLIC TRANSPORTATION |  |  |  |  |  |  |  |  |  |  | Amount
 |  |  |  | Check here if airfare was purchased directly by SWOSU |  |  |  |  |  |  |  |  | Total Public Transp (airfare, etc) |  |  |  | 0
ITEMIZED LOCAL TRANSPORTATION |  |  |  |  |  | [NAME] COSTS
 |  |  | TAXI: |  |  | REGISTRATION FEE: |  |  |  |  | (# of meals included in Registration_____ |  |  |  |  | )
 |  |  | SHUTTLE: |  |  | OTHER MISC. COSTS: |  |  |  |  | Other Explanation:
RENTAL CAR: |  |  |  |  |  | PARKING: |  |  |  |  |  | TOTAL ITEMIZED MISCELLANEOUS |  |  |  |  | 0
OTHER LOCAL TRANSP: |  |  |  |  |  | TOLLS: |  |  |  |  |  | TOTAL ITEMIZED LOCAL TRANSP |  |  |  |  | 0
 |  |  |  |  |  | BUSINESS FAX & PHONE: |  |  |  |  |  | TOTAL AMOUNT CLAIMED |  |  |  | 0
I, |  |  |  |  | , by signing here do under |  |  |  |  | I hereby approve this claim for payment and certify it complies with
penalty of perjury, declare that the information contained in this document and any attachments are true and correct to the best of my knowledge and belief. I have not benefited from the personal receipt of frequent travel miles earned from this travel. |  |  |  |  |  |  |  |  |  | the travel laws of the State of Oklahoma.
 |  |  |  |  |  |  |  |  |  | Agency's Approving Officer |  |  |  |  |  | Date
 | Claimant Signature |  |  |  |  |  |  | Date |  | (President, Vice President, Comptroller, or [NAME])