LUCIA MAR UNIFIED SCHOOL DISTRICT
BUSINESS OFFICE
CLAIM FOR * CONFERENCE * WORKSHOP * TRAVEL * MILEAGE * OTHER *
Claimant/Vendor:________________________________________________________________________________________
School/Dept/Address: ____________________________________________________________________________________
Conference Date: ________________________________________ Conference Site:__________________________________
Conference/Workshop Name: ______________________________________________________________________________
Name(s) of Attendee(s): __________________________________________________________________________________
Date Claim Prepared: ______________________________________ Date(s) Expense(s) Incurred: _____________________
CLAIM IS HEREBY MADE FOR COMPENSATION AS INDICATED
ATTACH: Original Receipts (not needed for meals or mileage) - Request for Approval, Conference/Travel (LM-OP-30) -
Conference Flyer/Registration - Proof of Attendance (ex: name tag, agenda, etc). Missing items may delay payment.
1. Lodging: _______ # of nights at $ ________ per night, including tax $ ________________________
2. Meals
: _______ breakfasts $ ________________________
_______ lunches $ ________________________
_______ dinners $ ________________________
3. Mileage: _______
miles driven
@ $10 each (depart by 7:00 a.m.)
@ $14 each (depart by 11:00 a.m.)
@ $30 each (return after 6:30 p.m.)
@ 58.5 cents/mile (personal vehicle)
$ ________
________________
Fuel – district vehicle $ ________________________
Airfare paid by employee: $ ________________________
Other travel expense(s):
(Details) $ ________________________
4. Conference/workshop registration paid by employee: $ ________________________
5. Miscellaneous Expense for: $ ________________________
TOTAL CLAIM: $ ________________________
CERTIFICATE OF CLAIMANT: I hereby certify that the above claim and the items, amounts, and statements as shown
are true and correct; that no part thereof has been previously paid, that the amount claimed is justly due me and is
presented within one year after the last items thereof have accrued.
SIGNATURE OF CLAIMANT: ___________________________________________________________________
PRINCIPAL/SUPERVISOR’S ACCEPTANCE OF CLAIM:
I hereby accept this claim and request it to be paid from:
ACCOUNT CODE: __________________________________________________________________________
SIGNATURE OF PRINCIPAL/SUPERVISOR: _________________________________________________________
LM-OP-29 2022
DISTRICT OFFICE USE ONLY:
Categorical/Other Funding Approval Director of Finance
* * * DO NOT FILL OUT FORM WITH BLACK INK * * * DO NOT FILL OUT FORM WITH BLACK INK * * *
* * * DO NOT FILL OUT FORM
OR SIGN FORM WITH BLACK INK * * *
