Comments:
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
or if
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: ____________________________
Date
: ________________________________________
Dept. Head Signature : ____________________________
Date
: __________________________________________
AVP for HR/Risk/Compliance Signature: ________________________________________________ Date Approved: ___________________
Grand Total:
Reimbursement Total:
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Employee Moving & Relocation Expense Form
Reset Form
Email Form
Employee Information
Employee ID
Last Name
First Name
Department Account Number
Date of Hire
Employment Status
Choose
Date of Move
Relocating From (home address):
Relocating To (home address):
Address:
Address:
City
State
ZipCode
City
State
ZipCode
Please answer the Distance Test and Time Test:
Clear Answers/Expenses
Does the move meet the IRS 50 mile distance test?
Choose
Is the position for 39 weeks or more?
Choose
Purpose
Expenses
Enter Amount
Enter Amount
Choose
Air Fare
Choose
Moving Co.
Choose
Truck Rental
Choose
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
unless cleared.
Storage 30 days or less
Storage over 30 days
Mileage
Choose
Lodging
Choose
Moving Supplies
Choose
Add'l Air Fare
Choose
Fuel-Truck Rental
Choose
Fuel-Car
Choose
Other: