Spreadsheet: 06545455-ed40-4d0b-a3df-82d0d414d757
Sheet: Sheet1

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TRAVEL and FOOD EXPENSE REIMBURSEMENT VOUCHER
 | DEPARTMENT, INSTITUTION, OR AGENCY: |  |  |  |  |  |  |  |  |  |  |  | DATE FORM COMPLETED |  |  |  |  |  |  | REASON(S) FOR TRAVEL (select from drop down menu):
 | PAYEE PERSONAL INFORMATION SECTION - PLEASE COMPLETE ACCURATELY TO EXPEDITE PAYMENT |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | TRAVELER CERTIFICATION
 | Name: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | I HEREBY CERTIFY THAT THE EXPENSES LISTED BELOW WERE INCURRED BY ME ON OFFICIAL BUSINESS OF THE COMMONWEALTH OF VIRGINIA AND INCLUDE ONLY SUCH EXPENSES AS WERE NECESSARY IN THE CONDUCT OF BUSINESS. I UNDERSTAND THAT I MUST COMPLETE A FOREIGN TRAVEL CERTIFICATION IF A PORTION OF MY FOREIGN TRAVEL WAS PERSONAL IN NATURE AND UNDERSTAND THAT THIS MAY RESULT IN MY REIMBURSEMENT BEING REPORTED AS TAXABLE INCOME.  ITEMIZED RECEIPTS FOR ALL TRAVEL AND FOOD EXPENSES OTHER THAN MEAL PER DIEM, MILEAGE, AND QUALIFYING EXPENSES OF $25 OR LESS HAVE BEEN INCLUDED WITH THIS REQUEST FOR REIMBURSEMENT.  I UNDERSTAND THAT IF ITEMIZED RECEIPTS WERE NOT SUBMITTED FOR MEAL EXPENSES WHERE ALCOHOL WAS CONSUMED THAT THE TOTAL AMOUNT OF THAT EXPENSE MUST BE PLACED ON LOCAL FUNDS.  MY SIGNATURE CERTIFIES THAT ALCOHOL PURCHASES HAVE BEEN CLEARLY IDENTIFIED ON THIS REIMBURSEMENT. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | DEPARTMENT CONTACT INFORMATION:
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Print           Name |  |  |  |  |  |  | Ext.
 | Address:
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | AUTHORIZED [NAME]
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | I HEREBY CERTIFY THAT THE TRAVEL UNDERTAKEN IN THIS REIMBURSEMENT VOUCHER HAS BEEN REVIEWED AND APPROVED AS NECESSARY FOR THE CONDUCT OF BUSINESS OF THE COMMONWEALTH.
 | City: |  |  |  |  |  |  |  | State: |  | Zip: |  |  | -
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | AUTHORIZED [NAME] SIGNATURE |  |  |  |  |  |  |  | DATE
 | [NAME]'s E-mail Address for Travel Receipt Notification: |  |  |  |  |  |  |  |  |  | Banner ID or S.S.N.:
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PRINTED NAME
 | VCU  EMPLOYEE? |  |  |  | YES           NO |  | TYPE OF VEHICLE DRIVEN : |  |  | PERSONAL                RENTAL                 STATE OWNED |  |  |  |  |  |  |  |  |  | SIGNATURE OF TRAVELER |  |  |  |  |  |  |  |  |  |  | DATE |  |  |  |  | DEAN or VP LEVEL SIGNATURE |  |  |  |  |  |  |  | DATE
 | PERSONAL DAYS WERE COMBINED WITH TRAVEL TO A FOREIGN DESTINATION |  |  |  |  |  |  |  |  |  |  |  | YES                  NO
 | IF YES, ATTACH COMPLETED FOREIGN TRAVEL CERTIFICATION FORM WITH OTHER REIMBURSEMENT DOCUMENTATION. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | TITLE |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PRINTED NAME
 | 1. DATE |  |  |  | 2. Location at which expense was incurred.  Points between which travel was necessary & method of transportation used . Each days expenses must be shown separately. |  |  |  |  |  |  |  |  | 3a. Miles Driven |  |  | 3b.   Enter Mileage Rate .560,  .565,  .246 |  | 4. Mileage amount to Reimburse |  |  | 5. Car Rental and Gas Expenses |  |  | 6. Taxis, Shuttles, Airfare, Baggage Fees, Train & other public  trans. |  | 7. Tolls and Parking. |  | 8. Per Diem Amt. |  |  | 9. Lodging Rate + Taxes and Fees |  |  | 10.            Business Meals |  |  | 11. Reg./Mtg.  Fees |  |  | 12. Other (Itemize in Column 2) |  |  | AMOUNT
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 | BANNER INDEX |  |  |  |  |  |  |  |  |  |  | TOTALS |  | 0 |  |  |  |  | 0 |  |  | 0 |  |  | 0 |  | 0 |  | 0 |  |  | 0 |  |  | 0 |  |  | 0 |  |  | 0 |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  | Do not type on lines 39 - 41 unless prompted to do so. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | TOTAL SHEET 2 |  |  |  |  |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | TOTAL SHEET 3 |  |  |  |  |  |  |  |  |  |  |  | 0 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | GRAND TOTAL |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | AMOUNT ADVANCED |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 | Business Purpose for Expenses and Explanation of Request for Exception (if applicable): |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | TOTAL DUE TO TRAVELER/   (TOTAL DUE BACK TO VCU) |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Rev 01/10/14