CITY OF HAMPTO
N
Travel Expense Voucher Date:
Employee Name
:
Department:
Automobile Used:
Year: Make: License No.
Dates of Travel: From: To:
Enter each trip separately below:
Date Beginning Ending Miles Departure Destination Explanation
$
I hereby certify that the above automobile was used for the listed trips and the total mileage expense of $ , hereby
requested, is true and correct and has not been previously requested
EMPLOYEE SIGNATURE DEPARTMENT HEAD APPROVAL
f:mileage
Form No. 020-20 REV 3 (4/99)
Speedometer Reading
X Cents =
TOTAL MILES