Date Time Date Time
Original Employee Paid Expenses
Receipt P-Card
Fund __________ Dept __________ Div __________ Cost Ctr __________ Object _________ $_________
Fund __________ Dept __________ Div __________ Cost Ctr __________ Object _________ $_________
Fund __________ Dept __________ Div __________ Cost Ctr __________ Object _________ $_________
Fund __________ Dept __________ Div __________ Cost Ctr __________ Object _________ $_________
Sun Mon Tues Weds Thurs Fri Sat Total
By signing below, I certify that the above information is true and correct to the best of my knowledge. I understand that falsifying
expense reports may result in diciplinary actions up to and including termination.
Dept Travel Approver Name:
Approver Signature:
Meals (per diem less provided meals) - Itemize below
Column B
Expenses Paid by City
Employee Name (Print)
Purpose of Trip
Transportation to/from airport
Transportation at Destination - Itemize below
Miscellaneous Expenses - explain below
Per diem rate schedule as set by the Federal Govt at:
Meal per diem - amount per day
Transportation costs - amount per day
Additional Comments (use attachments if necessary):
Expense Summary
Air Fare
Column A
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
Travel Claim Form Instructions
This form is to be used to itemize costs incurred for either an out-of-state trip, or an in-state trip with an overnight stay. All costs
related to the trip should be included on this form: Expenses pre-paid directly by the City, P-Card payments, pre-payments
reimbursed to the traveler by the City, and any out-of-pocket expenses incurred, whether covered by a travel advance or paid by
the traveler.
This form must be completed, signed, approved (attaching all necessary documentation) and turned in to the Finance
Department within 30 calendar days of returning from the trip.
The DOCUMENT ID # is the travel number assigned by the department. It consists of the 3 or 4-digit department/division number, the
letter “T”, the 2-digit year, and a 3 or 4-digit sequence number. It should match the number used on the related travel advance form.
The INFORMATION SECTION should include all required data.
The EXPENSE SUMMARY SECTION should include all cost incurred in each expense categoryRegistration, Air Fare,
Transportation, Mileage, Lodging, Meals and Miscellaneous Expenses.
1) EXPENSES PAID BY CITY (COLUMN A) - Total of all pre-payments/reimbursements made by the City as requested on the
travel advance form and any P-Card Payments
2) EMPLOYEE PAID EXPENSES (COLUMN B) Total of all costs paid by Employee
3) TOTAL TRAVEL EXPENSES Sum of all costs in Column A and Column B
4) SUBTRACT EXPENSES PRE-PAID BY CITY Subtract total of any expenses pre-paid by City in Column A (This will be a
negative amount)
5) NET EXPENSES Total of travel expenses minus Expenses Pre-Paid by City
6) SUBTRACT ANY REIMBURSEMENTS/TRAVEL ADVANCE Subtract total of any reimbursements or travel advances
received (This will be a negative amount)
7) TOTAL REIMBURSEMENT Difference between total travel expenses and the expenses pre-paid by city and travel
advances. If the advanced amount is greater than net expenses (i.e. the total reimbursement due is negative), the
traveler must repay the difference to the Finance Department and attach the receipt to this form. If this amount is
positive, it will be paid to the traveler by a City check
If applicable, the following documentation should be attached to this form (please mask all personal credit card numbers):
Travel Advance Form- If type of travel required this form. Finance Department will attach the form if it was sent to them
Registration Form/Brochure- Required to show cost, session and meal information. There is no need to attach to this form if it was
previously sent as back up to a pre-payment request.
Transportation- Passenger receipt for air travel is required. Attach receipts for taxi, bus or other ride service fees over
$25.00. Attach receipt for car rental, as well as a written explanation of the public purpose of, and authorization for, the expense.
Lodging- Itemized hotel bill is required. The single room rate must be noted if guest lodging is involved. Identify business phone
calls. Deduct meals and any other non-allowable costs included in the room charge.
Meals- Reimbursed at the US GSA per diem rates at 75% for travel days and at 100% while at destination. US GSA rates are located at Business meals and meals for others must have a receipt with the amount,
date, place, names and public purpose identified. Refer to current travel procedures for further details.
Miscellaneous- Receipts are required for gas/other costs for a City vehicle, laundry/dry cleaning charges if the trip is five days or
more, and parking expenses of $25.00 or more.