Fillable STATE OF VERMONT PERSONAL EXPENSE CLAIM (Vermont Judiciary)

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STATE OF VERMONT PERSONAL EXPENSE CLAIM (Vermont Judiciary)

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STATE OF VERMONT PERSONAL EXPENSE CLAIM
Name
Town of Residence
Department/Board or Commission
Address
Position Title
Social Security No.
Break-
Explanation
Date
fast
Total
Lunch
Dinner
Other
Lodging
I certify under the pains and penalties of perjury, that the foregoing is a correct statement of the time actually spent, mileage actually and constructively
traveled, and amounts necessarily incurred or paid by me in the discharge of my duties. (32 V.S.A. 464)
AAF6A
Claimant's Signature
Date
Supervisors Approval
Date
(01/2021)
FINANCE & MANAGEMENT
GRAND
TOTAL
Travel
Miles
Amount
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STATE OF VERMONT PERSONAL EXPENSE CLAIM (Vermont Judiciary)

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Completed 7 February 2021

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