Instructions: This form must be signed and submitted each time an Expense Report is created for reimbursement or payment
of employee moving/relocation expenses. To ensure the form calculates properly, please reset the form prior to use
changes are made to the distance test or 39 week answers below.
I certify the expenses above were incurred by me while moving and
relocating at the request of the University of North Georgia.
Please review these definitions which will help classify the moving expense purpose reported on this form
. Once you choose the purpose for the expense below,
the field to enter the amount will be activated. Trips for business purposes are not reportable.
Primary Move: The initial or primary move from the previous location to the new location.
House-hunting: Trips reimbursed for the purpose of finding a residence at the new location.
Employee Signature: ____________________________
Dept. Head Signature : ____________________________
AVP for HR/Risk/Compliance Signature: ________________________________________________ Date Approved: ___________________
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Employee Moving & Relocation Expense Form
Department Account Number
Relocating From (home address):
Relocating To (home address):
Please answer the Distance Test and Time Test:
Does the move meet the IRS 50 mile distance test?
Is the position for 39 weeks or more?
If you make changes to the answers in this section or the expenses below,
please click the Green Clear Button. The form will not calculate correctly