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IN‐STATEHOTEL/MOTELTAXEXCEPTIONFORM
(ForusewhenanexpensereportreimbursementissubmittedasaresultofanIn‐StateHotel/Motelproviderrefusingtoremove“occupancy
tax”fromatraveler’slodginginvoice.)
Completethefollowinginformation,obtainrequiredsignatureofDepartmentalApprovalAuthority,andsubmitwithExpense
ReporttotheOfficeoftheController.
EmployeeName:ADP ID#:
DatesofLodging:ExpenseReport#:
HotelName:HotelPhone#:
HotelAddress:
ContactNameHotelAuthority:
ReasonableExceptionRequest(
pleaseexplainthefactsandcircumstancesrelatingtoyourattempttoresolve
thehotel/motelagent’srefusaltoomit“occupancytax”onthelodgingdatesonwhichanexpensewasincurred):
Traveler’sSignature:Date:
(
Icertifyandattestthattheabovestatementsaretrue.IalsohavereadandunderstandtheUniversity’spolicyonIn‐State
Hotel/MotelTaxExemptionprocedures.)
DepartmentalApprovalSignature:Date:
Business&FinanceApprovalSignature:Date: