REQUEST FOR REIMBURSEMENT OF RELOCATION EXPENSES
Employee Name __________________________________
Department ______________________________________
Title______________________________________
Date of Hire _______________________________
Tax Treatment of Moving Expenses:
Moving expense reimbursements are considered to be wages by the Internal Revenue Service and as of January 1, 2018, are
considered taxable income. Once approved, moving expenses will be reimbursed through Payroll. It is the College’s understanding
that in order to satisfy IRS regulations, the move must meet the criteria listed below. For detailed information on moving
expenses, please refer to http://www.irs.gov/pub/irs-pdf/p521.pdf.
1. Distance Test, this is met if:
Your new work location is at least 5 miles farther from your former residence than your former work location was
from your
former residence. For example, if your prior work location was 3 miles from your former residence, your
new work
location must be at least 53 miles from that former residence.
2. Time Test, this is met if:
During the 12-month period immediately following the move, the taxpayer must expect to be employed full-time for
at least 39 weeks.
3. The move must be in connection with the commencement of work at the new location, and the expenses are
incurred within one year from the date you first report to work.
My signature below indicates that my move meets or is expected to meet all three criteria listed above.
________________________
________________________________________________________
Employee Signature
Date
Qualified Expenses
Transportation of Household Goods
Common Carrier
$
Moving Truck Rental (for self-moves)
$
Moving Truck Fuel
$
Insurance on Personal Possessions in Transit
$
Labor to Pack and Move Personal Possessions (up to a maximum of $500)
$
Packing Supplies
$
Temporary Storage (30 days or less)
$
Subtotal - Transportation of Goods
$
TRAVEL TO NEW RESIDENCE (FINAL MOVE)
Air or Train Fare: No. Passengers (Spouse & Dependents only)
______ x Airfare per Person $______
$
Rental Car
$
Rental Car Fuel
$
Travel by Personal Vehicle: Miles ______ x Rate $
______(IRS Standard Mileage Rate for moving)
$
Tolls, Parking, Shuttle Service
$
Lodging: No. of Nights _______ x Average Rate / Night $ _______
$
Subtotal - Travel
$
TOTAL QUALIFIED EXPENSES
$
0.00
0.00
0.18
0.00
0.00
0.00
0.00
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