"Monthly Mileage and Expense Report Form - Oakland Unified School District" - California

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Download "Monthly Mileage and Expense Report Form - Oakland Unified School District" - California

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Oakland Unified School District
ACCOUNTS PAYABLE DIVISION
1025 Second Ave. (Rm. 115C) - Oakland, CA 94606
Phone: (510) 879-8811
Fax: (510) 879-1773
MONTHLY MILEAGE AND EXPENSE REPORT
Mileage Reports must be submitted to Accounts Payable for reimbursement on a monthly basis.
(Please allow 20 working days for processing. Mileage claim over 60 days will not be reimbursed.)
Name_______________________________________ Ext. # _______________________ Date ______________
Music Teacher
909 LCI/Music Dept.
336-7609
Job Title _____________________________________ Work Site ___________________ Ext. # _____________
California Drivers License Number___________________________________ Expiration Date ______________
For Bridge Toll, Parking, etc. – Original receipt required.
Other
Expense
Date
Description (From/To, Purpose)
Mileage
Expenses*
Amount
Advance
____ Per mile (keep mileage records) (AFT, AFSCME, UTO, ESPO, BLDG. & GRDS)
IRS rate per mile (keep mileage records) OEA, UAOS, OSEA/UPE/790 - (White Collar), Non-Rep.
_____
eteria Rate
_____ Caf
PO # (if applicable) ________________Total Mileage _______________ Other Travel Expense_____________
Vendor #: ______________________________ _ Budget Account:________________________ - __________
(Org key)
(Object)
Total Expense Claim $__________________________
I hereby certify that the above is a correct and true statement of the actual and necessary expenses incurred by
me in the performance of official duties. I further certify that I carry personal vehicle property loss and damage
and personal liability insurance for any vehicle mileage expense claimed.
Examined and approved:
Claimant Signature ________________________________ Date ____________
Immediate Administrator Signature ____________________________________
Date________________
Accountability Department ___________________________________________
Date _______________
Please Note: If using restricted/categorical funds, this form must be approved by the Accountability Department.
08/2007
Oakland Unified School District
ACCOUNTS PAYABLE DIVISION
1025 Second Ave. (Rm. 115C) - Oakland, CA 94606
Phone: (510) 879-8811
Fax: (510) 879-1773
MONTHLY MILEAGE AND EXPENSE REPORT
Mileage Reports must be submitted to Accounts Payable for reimbursement on a monthly basis.
(Please allow 20 working days for processing. Mileage claim over 60 days will not be reimbursed.)
Name_______________________________________ Ext. # _______________________ Date ______________
Music Teacher
909 LCI/Music Dept.
336-7609
Job Title _____________________________________ Work Site ___________________ Ext. # _____________
California Drivers License Number___________________________________ Expiration Date ______________
For Bridge Toll, Parking, etc. – Original receipt required.
Other
Expense
Date
Description (From/To, Purpose)
Mileage
Expenses*
Amount
Advance
____ Per mile (keep mileage records) (AFT, AFSCME, UTO, ESPO, BLDG. & GRDS)
IRS rate per mile (keep mileage records) OEA, UAOS, OSEA/UPE/790 - (White Collar), Non-Rep.
_____
eteria Rate
_____ Caf
PO # (if applicable) ________________Total Mileage _______________ Other Travel Expense_____________
Vendor #: ______________________________ _ Budget Account:________________________ - __________
(Org key)
(Object)
Total Expense Claim $__________________________
I hereby certify that the above is a correct and true statement of the actual and necessary expenses incurred by
me in the performance of official duties. I further certify that I carry personal vehicle property loss and damage
and personal liability insurance for any vehicle mileage expense claimed.
Examined and approved:
Claimant Signature ________________________________ Date ____________
Immediate Administrator Signature ____________________________________
Date________________
Accountability Department ___________________________________________
Date _______________
Please Note: If using restricted/categorical funds, this form must be approved by the Accountability Department.
08/2007