Fillable - Purpose Actual Daily mileage reimbursable Receipt Date (Wharton County Junior College)

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- Purpose Actual Daily mileage reimbursable Receipt Date (Wharton County Junior College)

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BROWSE WHARTON COUNTY JUNIOR COLLEGE FORMS

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Revised 09-01-19
*effective 01/01/2020
Instructional Travel Form – Monthly Mileage Report (Reg. 484) MONTH _________________ YEAR
Name:
Date:
Address: City State Zip
Banner ID:
@
Dept: (check one) Full-Time Part-Time (check one) Campus Mail Mail to home
A
B
C
D
Date
Origin (residence)→Destination
1→Destination 2…→Final Destination
(residence)
Actual
Daily
Mileage
From
Origin to
Final
Destination
Deduction:
RT mileage
from
Residence to
Home Office
or
50 miles
for PT
faculty
Daily
reimbursable
mileage
(A minus B)
Parking
-
Receipt
Required
Purpose
Total Reimbursable Mileage for Month =
Mileage Rate
Totals
Total Reimbursement
Budget Account Number
Requestor’s signature _______________________________________ Date____________
Supervisor’s signature ______________________________________ Date____________
Vice President /Dean signature _________________________________ Date____________
0
.575
$ 0.00
$ 0.00
$ 0.00
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- Purpose Actual Daily mileage reimbursable Receipt Date (Wharton County Junior College)

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Completed 27 July 2020

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