Fillable TRAVEL VOUCHER MDCC BOX # OR MAILING ADDRESS (Mississippi Delta Community College)

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TRAVEL VOUCHER MDCC BOX # OR MAILING ADDRESS (Mississippi Delta Community College)

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TRAVEL VOUCHER
NAME DATE
ID# (do not use social security#) DEPARTMENT
MDCC BOX # OR MAILING ADDRESS
For mileage for privately owned auto used by me for transportation and for reimbursement of subsistence and
other authorized expenses paid by me in the discharge of official duty from_______________, 20_____
to _______________, 20_____. The itemized statement follows.
AMOUNT CLAIMED
IN-STATE TRAVEL
AMOUNT
OUT-OF-STATE TRAVEL
AMOUNT
771 MEALS & LODGING
781 MEALS & LODGING
775 GAS
785 GAS
772 TRAVEL
(AUTO-PRIVATE)
782 TRAVEL
(AUTO-PRIVATE)
774 TRAVEL
(PUBLIC CARRIER)
784 TRAVEL
(PUBLIC CARRIER)
776 OTHER TRAVEL COST
786 OTHER TRAVEL COST
SUB-TOTAL
IN-STATE
TRAVEL COST
SUB-TOTAL
OUT-OF-STATE
TRAVEL COST
LESS: TRAVEL ADVANCE
NET OUT-OF-STATE
TOTAL REIMBURSEMENT
REFUND
Subject to any difference determined by verification, I certify that the above amount claimed by me for travel
expenses for the period indicated is true and accurate in all respects, and that payment for any part has not been
received.
Signature of Employee____________________________________________Date___________________
MAXIMUM MEAL ALLOWANCE
BREAKFAST
DINNER
DAILY TOTALS
IN-STATE
4.00
11.00
20.00
OUT-OF-STATE
5.00
12.00
24.00
Supervisor/Division Chair/Dean DATE
Vice-President DATE
DATE
BREAK
FAST
LUNCH
DINNER
TOTAL
HOTEL/
MOTEL
TOTAL
MEALS &
LODGING
PURPOSE
TRAVEL TO
TOTAL
MILES
PUBLIC
CARRIER
OTHER
AUTHORIZED
EXPENSES
ITEM
AMOUNT
TOTAL MILES
GRAND
TOTAL
XXX
XXX
XXX
MILES @
Check the website
for mileage rate
XXXXXX
MEALS & LODGING 771_______________ 781_______________ MILEAGE 772_______________ 782_______________
PUBLIC CARRIER 774_______________ 784_______________
GAS 775_______________ 785_______________
OTHER 776_______________ 786_______________
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TRAVEL VOUCHER MDCC BOX OR MAILING ADDRESS (Mississippi Delta Community College)

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Completed 19 September 2020

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