C:\Users\X00204676\Documents\GroupWise\FN_Expense Reimbursement Form LLI 20191202.docx
LLI EXPENSE REIMBURSEMENT FORM
Form is used to request reimbursement for NON-TRAVEL expenses.
Contact the LLI Treasurer or LLI Liaison, Barb Jachna, 630-466-6804, if you have any questions.
NAME OF PERSON TO BE REIMBURSED – To be completed by LLI Member
Name: X #:
Street Address:
City, State, Zip:
Amount to be Reimbursed:
Purpose for Reimbursement:
To be completed by LLI Member - enter Quantity (QTY) and Unit Price for Total Cost to calculate.
Description
Unit of
Measure
Quantity
Unit Price Total Cost
Send completed form with backup documents to Barb Jachna, AUD 108.
Enclose detailed/itemized receipts and supporting documentation (event flyer,
etc.) in an envelope and staple envelope to this form. Please do not staple or
tape receipts to this form.
TOTAL:
Pr
ovide FOAPAL to be used for this reimbursement – to be completed by Community Education
FUND ORG. ACCOUNT PROGRAM ACTIVITY LOCATION
Administrative Signature / Community Education Date
click to sign
signature
click to edit
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