Out-of-Pocket Expense Report
_________
Reimbursement request for expenses paid from the employee or
student’s personal funds
Organization #
_______________________ _____________ _________________________ ___________________________
Name (Please Print) Email/Student ID Signature/Date Department Head Signature/Date
Please be sure to include a brief, yet specific purpose/description of all expenditures. _______________________________
If the expenditure is for meals or entertainment, list everyone who ate or was entertained. Officer Approval (if necessary)
Travel Expenses - Attach receipts
Date
Vendor
Amount
Description/ Purpose (to satisfy IRS requirements)
$
Mileage on personal auto-______miles x $.50
Total Travel Expenses
Other Expenses - Attach invoices, receipts, and/or other documents with descriptions sufficient enough to satisfy IRS requirements.
Date
Vendor
Amount
Orgn
Acct
Description/Purpose
$
Total Other Expenses
Total Expenses - Travel & Other
Advance (Enter as Negative)
Total Expenses Less Advance
Due To / From Employee
Submit a copy to the Business Office; retain a copy for your records.
If money is due from the employee,
please submit payment to the Cashier and
forward this form to Accounts Payable.
If money is due to the employee, please
submit directly to Accounts Payable.
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