Form 07-006 "Personal Expense Reimbursement Request" - Oregon

What Is Form 07-006?

This is a legal form that was released by the Oregon Department of Administrative Services - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 15, 2021;
  • The latest edition provided by the Oregon Department of Administrative Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 07-006 by clicking the link below or browse more documents and templates provided by the Oregon Department of Administrative Services.

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Download Form 07-006 "Personal Expense Reimbursement Request" - Oregon

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Fleet & Parking Services
State of Oregon
1100 Airport Rd SE
Personal Expense Reimbursement Request
Salem, OR 97301-6082
503-378-6937
503-378-5813 fax
fleet.fuel@oregon.gov
Form 07-006
https://www.oregon.gov/DAS/FleetPark
Agency Name
Unit/Section/Division
Driver Name (last name, first name)
Address (reimbursement will be mailed to this address*)
City
State
Zip
Employee ID
Email Address
Phone Number
OR_____________________
A
Reason for Expense (must be filled out to process request)
Date of Expense
Amount of Expense
Motor Pool Vehicle Plate #
Odometer Reading (on Date of Expense)
*If you have set up automatic deposit for expense reimbursements with your payroll department, this reimbursement will be auto-deposited.
The above named driver incurred an expense in the amount stated while operating the above mentioned vehicle on
official state business.
B
Driver Signature
:
_________________________________________________________________________________________________________________________
Attach receipt here (a scanned copy is acceptable).
C
MOTOR POOL USE ONLY
Approval Signature
Date
Agency #
Cost Center
Processing Fee: $
No Processing Fee
U:\ADMN\Published\Forms\Personal Expense Reimbursement Request.docx
07-006
Revised 1/15/2021
Fleet & Parking Services
State of Oregon
1100 Airport Rd SE
Personal Expense Reimbursement Request
Salem, OR 97301-6082
503-378-6937
503-378-5813 fax
fleet.fuel@oregon.gov
Form 07-006
https://www.oregon.gov/DAS/FleetPark
Agency Name
Unit/Section/Division
Driver Name (last name, first name)
Address (reimbursement will be mailed to this address*)
City
State
Zip
Employee ID
Email Address
Phone Number
OR_____________________
A
Reason for Expense (must be filled out to process request)
Date of Expense
Amount of Expense
Motor Pool Vehicle Plate #
Odometer Reading (on Date of Expense)
*If you have set up automatic deposit for expense reimbursements with your payroll department, this reimbursement will be auto-deposited.
The above named driver incurred an expense in the amount stated while operating the above mentioned vehicle on
official state business.
B
Driver Signature
:
_________________________________________________________________________________________________________________________
Attach receipt here (a scanned copy is acceptable).
C
MOTOR POOL USE ONLY
Approval Signature
Date
Agency #
Cost Center
Processing Fee: $
No Processing Fee
U:\ADMN\Published\Forms\Personal Expense Reimbursement Request.docx
07-006
Revised 1/15/2021