TRAVEL EXPENSE ACCOUNT - LOUISIANA TECH UNIVERSITY AUTHORIZATION NO.
The statement on the reverse side must be completely filled in by the payee prior to signature.
Receipts must be attached, as required by travel regulations. White and blue copies to be turned
DATE OF CLAIM
in to Comptroller's Office.
NAME OF OFFICER OR EMPLOYEE DEPARTMENT CODE
ADDRESS FOR PERIOD
CITY LIMITATION BY BUDGET HEAD
$
EXPENSE SUMMARY
Automobile: Per Mile Cost:
mi. @
$0.57
$
mi. @
$0.57
$ $
Subsistence:
Lodging $
Meals $ $
Tolls and Parking $
Other Expenses $
Total Reimbursable Costs $
Less: $
Less: $
Total Paid $
CERTIFICATE OF PAYEE
I certify that this expense account is just and true in all respects; that the distances shown were actually and necessarily traveled on the dates
specified on official business only; that the expenses charged were incurred on official business of the State and none of the expenses have been
paid by the State; and that the full amount is justly due.
SIGNED BY PAYEE TITLE OR POSITION OFFICIAL DOMICILE
Ruston, LA
CERTIFICATE OF HEAD OF BUDGET UNIT
I certify that the charges set forth on this expense account have been examined by me; that the services for which the charges are made were
necessary and proper; and that, in my opinion, the amounts claimed are just and reasonable.
SIGNED BY: NAME TITLE
REMARKS (INCLUDE PURPOSE, EXPLANATION OF UNUSUAL ITEMS, & NAMES OF PERSONS INCLUDED IF MORE THAN ONE)
TO BE COMPLETED BY COMPTROLLER
DATE PAID ACCOUNT TO BE CHARGED
CLASS DEPT. Budget-Object FUND NO. AMOUNT
CHECK NO.
AUDITED BY
APPROVED
(Comptroller)
4/76-2 1/2M Voucher No.
AMOUNT
MILES
OVER
TERRITORY TRAVELED--
TRAV.
MEALS & TIPS
TOLLS
DAILY
DATE
DEP.
ARR.
SHOW ALL POINTS VISITED
Depart
Arrive
(IF TO BE
LODGING
FOR MEALS
AND
MAXIMUM
CLAIMED)
NO.
COST
PARK.
DESCRIPTION
COST
L-LODGING
M-MEALS
TOTALS
OTHER EXPENSES
HOUR
(Specify AM/PM)
ODOMETER READING
SUBSISTENCE
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