VENDOR #__________ MANISTEE COUNTY
TRAVEL EXPENSE STATEMENT
DATE SUBMITTED______________
COUNTY DEPARTMENT OR COURT
PERIOD COVERED
NAME OF EMPLOYEE TITLE OR POSITION
FROM TO___________
______________________________________________________________________________
HOME ADDRESS (STREET, CITY, STATE, ZIP)
DATE DESCRIPTION MILES MILEAGE
AMOUNT
LODGING MEALS OTHER
TOTAL
SUMMARY
TOTALS
PLEASE BE ADVISED THAT ALL LODGING
EXPENSES MUST BE SUPPORTED BY A RECEIPT OR
THEY WILL NOT BE PAID.
NO EXCEPTIONS!!
I HEREBY CERTIFY THAT ALL ITEMS OF EXPENSE INCLUDED INTHIS STATEMENT WERE
INCURRED IN THE DISCHARGE OF AUTHORIZED OFFICIAL BUSINESS; THAT THE AMOUNTS
ARE CORRECT; AND THAT THEY REPRESENT PROPER CHARGES AGAINST THE COUNTY.
EMPLOYEE SIGNATURE DATE
SUPERVISOR SIGNATURE DATE
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FOR FINANCE OFFICE USE ONLY
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ACCT #
AMT.
ACCT # AMT.
ACCT # AMT.
