San Diego Community College District Payee ID:
3375 Camino del Rio South, San Diego, CA 92108-3883
MONTHLY REQUEST FOR MILEAGE REFUND FOR USE OF PRIVATELY OWNED CARS
(See Education Code Section 44033 for Authority)
DO NOT USE THIS SPACE
Name:
First M.I. Last (Please Print)
Department: Colleague ID:
Campus/Site: Phone:
Send the top copy with appropriate signatures to Accounts Payable, District Business Services Office or to your Campus Administrative Office. Keep the second
copy for your records. This request should not include travel outside San Diego County. Attach receipts when claiming parking, tolls, etc.
Date Destination Business Purpose No. of Parking,
MM/DD/YY From To Miles Tolls, etc.
Total Number of Miles
Times Standard Mileage Rate/Mile
Total Mileage/Total Parking, Toll etc.
Total Amount Claimed for Refund ---------------------------->
Mileage for Month Ending:
I hereby certify that I incurred the above mileage and related expenses in the performance of my official duties, that the information given is
true and correct, that no part of the travel was performed outside San Diego County; and I hereby present my claim for refund.
Employee's Signature______________________ Date______________________
Approval Signature _______________________ Date______________________
Approver's Name _________________________ Position___________________
Invoice Number Fund DTL. Fund Cost Ctr. Program Object Amount Description/Comment
Total Amount Page____ of _____
