Department
Division
Agency Code 360228
Sunday Monday Tuesday Wednesday Thursday Friday Saturday Totals
Plane Railroad Bus Other
Date
Day Start End Total Miles
Total
Commute
Miles
Reimbursed
Miles *
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
*Compute equal to total miles if applicable
*January 1, 2020 - December 31, 2020 Mileage Rate is 57.5 cents per mile
*January 1, 2019 - December 31, 2019 Mileage Rate is 58.0 cents per mile
*Mileage Instructions
Date:
Approved by: Approved by:
Approved by:
Title:
Mileage
Parking
Registration Fee
Method of Travel
Purpose of Travel
T #
Program
Project
PO#
Receipt #
Other
Employee Name
Employee Address
Employee Soc. Sec. #
Dinner
Chartfield Information
Account
Department
Fund
For Period Beginning
Territory Covered Incurring Above Expenses
Day
Date
Hotel Room
Breakfast
Lunch
Telephone
Fare (indicate below)
Taxi
Other
Other
Bridge or Road Tolls
Immediate Supervisor
Total Reimbursed Miles
Certified just and correct and payment not received
Signature of Employee
State of Maryland Expense Form
Total Travel Costs
Authorized Signature
Print
Print Name (Authorized Approver)
Updated 01 07 2019 gb
Contact Information
Gierra Bailey ext. 4747
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