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Text File  |  1991-06-08  |  1.2 KB  |  54 lines
  1.                       EXPENSE ACCOUNT STATEMENT
  2.  
  3.  
  4.  
  5.  
  6.  
  7.  
  8. Employee:_________________________________________________________
  9. For period ending:________________________________________________
  10.  
  11.  
  12.  
  13.  
  14.                     REIMBURSABLE EXPENSES INCURRED
  15.  
  16.  
  17. Hotel/Lodging $_________________________
  18. Meals $_________________________
  19. Tax $_________________________
  20. Travel [air, train, bus] $_________________________
  21. Personal auto _____ miles x ___ cents $_________________________
  22. Parking $_________________________
  23. Phone $_________________________
  24. Other [itemize]:
  25.                 _____________________ $_________________________
  26.                 _____________________ $_________________________
  27.                 _____________________ $_________________________
  28.                 _____________________ $_________________________
  29. Total: $_________________________
  30. -------------------------
  31.  
  32.  
  33.      I certify the above is a true statement of incurred
  34. expenses in accordance with company policy.  Receipts are
  35. attached.
  36.  
  37.  
  38.  
  39.  
  40. _______________________________
  41.                                                Employee
  42.  
  43.  
  44.  
  45.  
  46. Approved for payment:
  47.  
  48.  
  49.  
  50.  
  51. By:_____________________________
  52.  
  53.  
  54.