Form D.F.C. 6 Rev7-90
STATE OF ALABAMA
Original for
STATEMENT OF OFFICIAL TRAVEL
Comptroller
(Department or Agency) Code Number) (Division)
Pay from Funds
Approved
Director of Title III
Official Station or Base Above Space for Name and Address of Employee
POINTS OF TRAVEL
Hour of
Depa
rture
Hour of Return
To Base
Month
and Date
From
To
Private
Car.
Miles
Fare or
Travel
Tax
Exem
pt
A.M. P.M. A.M. P.M.
Number
Un
its
@ - ¼
Daily
Rate
Amount Per
Diem
Claimed
TOTAL AMOUNT FOR TRANSPORTATION TOTAL PER DIEM
Detail miscellaneous expense and furnish receipts when required. This space
for departmental approval, etc. Use extra sheets when necessary.
TOTAL THIS EXPENSE ACCOUNT
I HEREBY CERTIFY that the travel and expense in-
dicated hereon was accomplished in the performance of
official duties pursuant to travel authority granted me.
(Signature of traveler)
Sworn to and subscribed before me this the
day of 20
(Notary Public)
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