State Hosting Reimbursement Request – SDCL 3-9-2.1
When Application and Authorization sections are completed, please submit the original to:
State Board of Finance - Office of Secretary of State
Capitol Building - 500 E Capitol Ave - Pierre, SD 57501
Phone: 605-773-3537
PLEASE NOTE: The request and all supporting documentation must be received in the Office of the Secretary of
State no later than 5:00 p.m. CT eight days prior to the Board of Finance meeting on the third Tuesday of the
month. Documentation received after that time will be processed at the next Board of Finance meeting. All
documentation MUST comply with Bureau of Human Resources policies regarding protection of personally identifiable
information.
Date: _____________________________
Application
A
gency:
Agency Address:
Agency Phone Number:
Employee Requesting Reimbursement:
Total Amount of Reimbursement:
Date(s) of Hosting Expense:
Receipts Attached: Y / N
Explanation of official business performed:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
I hereby request authorization and approval for reimbursement of expenses, set forth in the voucher attached hereto, that were
incurred while hosting a prospect for business development, trade, or a tourism promotional activity. I certify that the
expenses were incurred through necessary duties of my employment with the State of South Dakota and in the furtherance of
state’s interests, concerns, and activities and are supported by the attached receipts. I declare and affirm under the penalties
of perjury that this claim has been examined by me, and to the best of my knowledge and belief, is in all things true and
correct.
Signature of Employee Date
Authorization
I hereby certify that the above employee was authorized to incur the claimed expenses while performing necessary duties of
their employment on behalf of the State of South Dakota. I attest that the employee’s claims were in the furtherance of state
interests relating to hosting a prospect for business development, trade, or a tourism promotional activity.
Name of Department/Office Head Position/Title of Agency Official
Sig
nature of Department/Office Head Date
State Board of Finance Approval
Approval Date:
Signature of Secretary, State Board of Finance
Note: When completed, attach the original form and receipts to voucher to be sent to the State Auditor’s Office.
