MINNESOTA STATE COLLEGES AND UNIVERSITIES
Mesabi Range College
001 Chestnut Street West
Virginia, MN 55792-3401
AFFIDAVIT FOR EMPLOYEE REIMBURSEMENT
State of Minnesota
, being first duly sworn, says that
he/she is an employee of the State of Minnesota, Minnesota State Colleges and Universities, and
Purchased a ticket for transportation from
Paid a registration fee of $
And further, that a receipt was not obtained for the above expenditure(s).
And further, that a receipt was obtained but that it was lost.
is expense was incurred as an employee of the State of Minnesota on official business.
Subscribed and sworn before me this
Updated August 2012
Updated March 2014 (fillable .pdf)