Spreadsheet: 14a2ba37-b3ea-41e8-8783-23baa8f353c3
Sheet: Sheet1

Unnamed: 0 | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | State of Colorado | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19
 |  |  |  |  |  |  |  | TRAVEL EXPENSE
Department: |  |  | EID: |  |  |  |  | Division or Agency: |  |  |  |  |  |  |  | Month |  |  | FY13
Date |  | Travel |  |  | Time Depart | Time Return |  | Mileage |  |  |  | Meals and Lodging |  |  |  |  |  |  | Total Reimbur. Expenses
 |  | From | To |  |  |  |  | No. Miles | Rate Per Mile | Total |  | Bkst. | Lunch | Dinner | $5 Incidental | Lodg. | Total
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
 |  |  |  |  |  |  |  |  | 0.51 | 0 |  |  |  |  |  |  | 0 |  | 0
TOTALS |  |  |  |  |  |  |  | 0 |  | 0 |  | 0 | 0 | 0 | 0 | 0 | 0 |  | 0
Miscellaneous Expenses:
Purpose of Trip: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Total Expenses |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Less Travel Advance
Persons and Agencies Contacted: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | TOTAL |  |  | 0
"I certify that the statements in the above schedule are true and correct in all respects; that payment of the amounts claimed herein has not and will not be reimbursed to me from any other source; that travel performed for which an vance or reimbursement is claimed was or will be performed by me while on State Business and that no claims are included for expenses of a personal or political nature or for any other expenses not authorized by the Fiscal Rules; and that I actually incurred or paid the operating expenses of the motor vehicle for which reimbursement is claimed on a mileage basis. Further, I hereby authorize the State to deduct from my pay any amount paid to me in excess of my authorized expenses as provided by Fiscal Rule 5-1.”
Payee Signature                                               Date |  |  |  |  |  |  |  | Mail Address:
Payee Print |  |  |  |  |  |  |  | ________________________________________________________________________
RECOMMENDED FOR APPROVAL
__________ |  | Please pay by electronic funds transfer |  |  |  |  |  |  | __________ | Establish Record for EFT
Fiscal Officer |  |  |  |  |  |  |  | Supervisor |  |  |  |  | Executive Director
FUND | AGCY | AGCY | ORG  -  SUB |  | APPROP | PROG |  | FUNC | OBJ  - SUB | B/S |  | GBL | RPTG |  | JOB/PROG |  | AMOUNT
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  | TOTAL |  | 0
6-AC-02
Form 2-70 (Rev. 01/13)
615-82-50-0023
TRAVEL LOG
Date: |  | From: |  |  |  |  |  |  | To: |  |  |  |  |  |  |  |  |  | Total Miles:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | TOTAL Mileage: |  |  | 0