Spreadsheet: 91b9b656-ef73-4698-a476-44a072f1ca9d
Sheet: Sheet1

Unnamed: 0 | [NAME] Name: | Unnamed: 2 | _____________________________________ | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Trip Dates: From (M/D/Y) _________ | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Through (M/D/Y) __________ | UPDATED DECEMBER 2012
 | Street Address: |  | _____________________________________ |  |  |  | Trip Locations: ______________________________________________
 | City, State, Zip: |  | _____________________________________ |  |  |  | Trip Purpose:   ______________________________________________
 |  |  |  |  |  | Hold check for _________________________________ |  |  |  |  |  | Vendor #:______________________________
 | Please report all expenses in U.S. Dollars (see Instructions)
 |  | Meals |  |  |  | Lodging | Transportation Expenses |  |  | Miscellaneous
 | Date (M/D/Y) | [NAME]'s Breakfast | [NAME]'s Lunch | [NAME]'s Dinner | Entertainment 3 | Lodging (room and taxes only) | Airfare / Train / Bus 1,3 | Local                  (e.g., taxi;        auto rental 1) | Personal Vehicle (plus tolls & parking) 2 | Tel/Fax/     Internet | Tips | Other 3
 | TOTAL | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0
 | SUMMARY EXPENSES |  |  |  |  |  | SIGNATURES
 | Category | Account Number |  |  | Total | Controller's Office Only | Traveler: |  |  |  | Date:
 | Meals | -        - 8232 - |  |  | 0 |  | Authorized by: |  |  |  | Date:
 | Lodging | -        - 8233 - |  |  | 0 |  | Reviewed by: |  |  |  | Date:
 | Travel | -        - 8231 - |  |  | 0 |  | Controller: |  |  |  | Date:
 | [NAME]. | -        - 8234 - |  |  | 0 |  | Obligation #: |  |  |  | Date:
 | Total Expenses |  |  |  | 0 |  | Check #: |  |  |  | Date:
 | Less Advance received                                                Account Number:    -   -    -0000 |  |  |  |  |  | 1   Ticket, original receipts and/or auto rental approval letter must be attached
 | Less DFMS paid (e.g., via A & I Travel)             Invoice No. from Ticket Stub |  |  |  |  |  | 2   $0.565 per mile plus tolls and parking (please itemize on reverse)
 | Reimbursement due [NAME] (or to DFMS) |  |  |  | 0 |  | 3   Please itemize on reverse
 | Please read instructions on last page and the reimbursement guidelines posted online at: http://www.episcopalchurch.org/finance_17451_ENG_HTM.htm
 | ITEMIZED EXPENSES
 | Entertainment
 | Date | Place of Entertainment |  |  | Cost | Names of Individuals Entertained |  |  | Business Purpose
 | Auto Rental Expenses (attach authorization letter) and [NAME] (specify)
 | Date | Amount | Description |  |  |  | Date | Amount | Description
 | Personal Automobile Use (Reimbursed at $0.565 per mile; gasoline is not reimbursable)
 | Date | From/To City |  |  | [NAME] | Persons Transported |  |  | Comments
 | Foreign Currency (list) |  |  | Conversion Rate per US Dollar (e.g., 20 pesos per USD) |  |  |  | Date/s of Conversion (average for travel dates)
 | INSTRUCTIONS
 | Please type or print clearly.  Please securely attach receipts (with tape) to  blank sheets of 8 1/2 by 11 paper (using both sides to help the environment).
 | Expenses can be reimbursed only by submitting a properly completed and approved Travel & Expense Report form.  This Form must be accompanied by original receipts or stubs for all expenditures other than tips.  The completed form should be forwarded to your [NAME] or meeting organizer for approval and submission to the Controller's Office within 14 calendar days following each trip or incurring entertainment and telephone expenses.  Expenses submitted after 60 days will not be reimbursed.
 | If the U.S. dollar amounts stated on the Form are derived after converting from a foreign currency, please include a copy of the source document used for conversion.  This document should clearly show the rate or conversion factor that was used in the computations.  We suggest using the converter available at http://www.oanda.com/convert/fxhistory.
 | Expenses that are generally subject to reimbursement
 | The following are usually accepted for reimbursement: transportation, lodging, meals, and certain miscellaneous expenses.  Details are provided in the Guidelines for Official Travel available at http://www.episcopalchurch.org/finance_17451_ENG_HTM.htm
 | Expenses that are not subject to reimbursement
 | Any expenses not specifically addressed in the Guidelines as reimbursable must have prior written explanation and approval.  Non-reimbursable expenses include but are not limited to the following: Spouse's travel expenses; dependent care; pet care; supply clergy to substitute for clergy on official business; lost pay; use of frequent-[NAME]; additional travel insurance; luggage purchase or replacement; unofficial (personal) entertainment; in-room movies; barber and beauty services; newspapers and magazines; sightseeing; medical services; motor vehicle fines; "no show" charges for hotels, car rental and limousines; charge card late fees and expenses; alcoholic beverages (Exceptions may be made for alcoholic beverages for official entertainment)
 | Submitting a Request for Reimbursement
 | Receipts should be taped or stapled to blank sheets of letter sized paper, and properly spaced so that all the numbers on each receipt are clearly identifiable. These blank sheets should then be attached to the T & E form.  We request that you not bunch and staple receipts one behind the other.
 | Please direct all requests for reimbursement to the staff person through whom the meeting arrangements were made.
 | Requests for reimbursement for group travel for Members of Committees, Commissions, Agencies and Boards of the General Convention or Executive Council should be sent to:  The General Convention Office, The Episcopal Church Center, 815 Second Avenue, New York, NY 10017, [NAME]: ([PHONE])