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Clarion University Travel Expense Voucher
TRAVELER’S NAME (Print Clearly) DEPARTMENT
TRAVELER’S ACCOUNTS PAYABLE VENDOR NUMBER CAMPUS
Clarion Venango Pittsburgh Erie
RESIDENCE STREET ADDRESS CLASS TITLE
CITY AND STATE ZIP CODE BARGAINING UNIT OFFICE TELEPHONE NUMBER
TO BE COMPLETED BY TRAVELER:
YEAR ACCOUNT NUMBER AMOUNT
JUSTIFICATION:
DATE
ITINERARY
TRANSPORTATION
LODGING
SUBSISTENCE
MISCELLANEOUS EXPENSES
TIME
PERS.
AUTO
MILES
NAME
OF CARRIER
CASH YOU
PAID
NAME
OF HOTEL
CASH YOU
PAID
CASH YOU
PAID
EXPLANATION CASH
LV RET
LIST LOCATIONS
TOTALS
PERSONAL AUTO
MILES @ ¢ = $
SUPERVISOR’S SIGNATURE AND DATE
I CERTIFY THAT THE STATEMENTS AND EXPENSES CLAIMED ARE CORRECT, REASONABLE AND WERE
INCURRED IN THE PERFORMANCE OF UNIVERSITY DUTIES AND THAT I HAVE NOT AND WILL NOT
ACCEPT REIMBURSEMENT OF ANY OF THESE EXPENSES FROM ANY OTHER SOURCE. I FURTHER
CERTIFY THAT IF MY PERSONAL AUTOMOBILE WAS USED FOR UNIVERSITY BUSINESS DURING THE
PERIOD OF TRAVEL CLAIMED, INSURANCE COVERAGE WAS IN EFFECT TO COMPLY WITH
PENNSYLVANIA INSURANCE REGULATIONS.
TRAVELER SIGNATURE AND DATE SUPERVISOR SIGNATURE AND DATE
Total Reimbursement
Claimed
$
$
Personal Automobile
Allowance
ENTERPRISE RENT-A-CAR
Complete this form, print, obtain approval signatures, attach receipts, and forward to Accounts Payable.
Totals
I certify that the statement and expenses claimed are correct, reasonable and were
incurred in the performance of University duties and that I have not and will not
accept reimbursement of any of these expenses from any other source. I further
certify that if my personal automobile was used for University business during the
period of travel claimed, insurance coverage was in affect to comply with the
Pennsylvania Motor Vehicle Financial Responsibility Law (Act 1984-11).
__________________________________ _________________________________
TRAVELER SIGNATURE AND DATE SUPERVISOR SIGNATURE AND DATE
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