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Warning Text %XTableStyleMedium2PivotStyleLight16`PSheet1=Sheet2͇Sheet35K@TITLE:NAME OF TRAVELER:ADDRESS:1ACCOUNT/BUDGET NUMBERS TO POST TRAVEL CHARGES TO:OBJECT EXPENSE - ACCOUNT CODEFUND DEPARTMENTPROGRAMCLASSGRANT TRAVEL FROM TRAVEL TO BREAKFASTLUNCHDINNER#LODGING (ORIGINAL RECEIPT REQUIRED)CITY, STATE, ZIP PHONE NUMBER: FOOD TOTALPERSONAL MILES DAILY MILESDATE OF TRAVEL DEPART TIME ARRIVAL TIMEODOMETER READING STARTODOMETER READING END VOUCHER #BATCH #ACCOUNTAMOUNTSWORN STATEMENT AND APPROVALTraveler's Signature:Date:Date of ExpenseAmountTotal Registration,Total Common Carrier, Taxi/Limousine,ParkingTotal MiscellaneousFOR ACCOUNTING OFFICE USE ONLYLICENSE PLATE NUMBER OF CAR: STATE MILES ----------- REIMB $$TOTALS:+TOTAL SUBMITTED FOR REIMBURSEMENT: *Registration Fee (Attach ORIGINAL Receipt)6Air, Taxi/Limousine, Parking (Attach ORIGINAL Receipt)QAuthorized Approver for Budget Unit (Required & Must be Different than Traveler)& EAll Other Miscellaneous Expense (Explain and Attach ORIGINAL Receipt)AI do solemnly swear, under criminal penalty of a felony for false statements subject to punishment by not less than one year nor more than twenty years of penal servitude, that the above statements are true and I have incurred the described expenses and the state use mileage in the discharge of my official duties for the state and have not been reimbursed and have not filed nor will file for reimbursment from any other source for said expenses. 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