Date:
Payee:
Address:
Department:
Traveler Signature:
Date:
Date:
Martha Aucoin - Accounting Technician (or designee)
Date:
Wendell Coplin - Interim VCFA (or designee)
Beginning Odometer Reading:
Grant/Contract/Project Name (If Applicable)
Ending Odometer Reading:
Supervisor
REIMBURSEMENT TOTAL
Confirm Departure Time:
Confirm Return Time:
___________
___________
*
*
Explain Misc. Expenses:
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Louisiana Delta Community College
Travel Expense Reimbursement Voucher
Rev 09/30/2017
The approved travel authorization form and any other applicable travel forms or documents are attached. This includes, but not limited
to, the personal mileage reimbursement log, meeting/conference agendas and original signed receipts. I understand the reimbursment
request cannot be processed if any required items are missing. I certify the expenses are true, accurate and were incurred for LDCC
college business.
DATE (fill in day # only)
TOTALS
DAY
SUN MON TUE WED THUR FRI SAT
BREAKFAST
LUNCH
DINNER
TOTAL MEALS
Attach original signed receipts for expense listed below to back of form.
LODGING (Taxes Included)
TOLLS AND PARKING
TIPS
AIRFARE
TAXI
CAR RENTAL
REGISTRATION FEES
MISCELLANEOUS
TOTAL
Personal vehicle usage:
miles @ $0.53 (Maximum 99 miles per round trip)
Approved:
Audited By:
Payment Approval:
FUND ORGN ACCT PROG ACTIVITY AMOUNT
