Spreadsheet: 64f64a03-6783-48a6-abc1-273dc92424e0
Sheet: Sheet1

Instruction for completing Travel Reimbursement Form: | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8
Complete all items above the "Federal Guidelines" message.  Use the link below to access the GSA website to locate the per diem rate for your area of travel.  Some fields
will automatically populate in the expenses grid.  [NAME] in the dates in the expenses grid  for the dates that you were gone.  Don't include the last day you were gone because it
will be automatically filled in on the departure line.  For any meals included in the registration for the event attended, make sure the "Less" fields are correct.  Use the
information in the table below to determine the amount for each meal based on the total per diem rate for the area of travel.  Enter the first night's lodging on the departure
date, and all other lodging should populate automatically.  If, for some reason, there is a different amount for any day, simply type that amount into the correct field.  Other
charges such as phone, parking, fuel for county vehicles (except that purchased with a county credit card) should be totaled for each day and manually entered into the
correct fields.  Most totals will populate for you with the exception of the other charges which need to be broken down into the appropriate categories.  Phone charges should
be totaled and entered on the Phone total, fuel changes should be totaled and entered on the Fuel total, and parking, etc. should be totaled and entered on the Other total
with an explanation of what it is.  This assures that all expenses are charged to the correct line items in your budget.  If you drove your own vehicle, complete the mileage
grid.  Trip miles, Totals, and the amount of mileage reimbursement will be calculated for you.  Print the form and sign it.  You should just be able to click print as the print area
has been set.  Forward to the appropriate person for processing.  Include the original copies of all receipts for everything except food.
 | Per Diem Rates from GSA
 | M&IE Total | 46 | 51 | 56 | 61 | 66 | 71
 | Breakfast | 7 | 8 | 9 | 10 | 11 | 12
 | Lunch | 11 | 12 | 13 | 15 | 16 | 18
 | Dinner | 23 | 26 | 29 | 31 | 34 | 36
 | Incidentals | 5 | 5 | 5 | 5 | 5 | 5
Revised Date:
10-2009
Washington County, Arkansas
Travel Expense Reimbursement Form
Name: |  |  |  |  |  |  | Date: | 2011-03-08 00:00:00
Department: |  |  |  |  |  |  | Meals Per Diem:
Destination: |  |  |  |  |  |  | Departure Date:
Purpose of Trip: |  |  |  |  |  |  | Return Date:
**Per Federal Guidelines, the County only allows 75% of meal allowance on departure and return dates.
Expenses |  |  | Less Conference/Training paid Meals
 | Date | Meal Allowance | Breakfast | Lunch | Dinner | Lodging | Other Charges | Total
Departure | 00:00:00 | 0 |  |  |  |  |  | 0
 |  | 0 |  |  |  | 0 |  | 0
 |  | 0 |  |  |  | 0 |  | 0
 |  | 0 |  |  |  | 0 |  | 0
 |  | 0 |  |  |  | 0 |  | 0
 |  | 0 |  |  |  | 0 |  | 0
Return | 00:00:00 | 0 |  |  |  |  |  | 0
 | Totals | 0 | 0 | 0 | 0 | 0 | 0 | 0
Mileage
 |  | Location |  |  |  | Odometer |  | Total
 | Date | From |  | To |  | Start | End | [NAME]
 |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  | Total Miles | 0
 |  |  |  |  |  | Total Miles                  X | Rate
 |  |  |  |  |  | 0 | 0.51 | 0
 | Amount | Line Item | Explanation of (a) & (b)
Meals | 0 | -3094
Lodging | 0 | -3094
Phone |  | -3020
Mileage | 0 | -3032
Gas & Oil |  | -2007
[NAME] |  | -3031
Auto Rental |  | -3073
Other (a)
Other (b) |  | -3100
Total Expenses | 0
I certify the above report is correct, and that I have read and adhere to the County's Travel Policy.
Employee's Signature
Elected Official/Department Head
Do not write below this line
Verified by_____________________________________________________________________    Date____________________________