Household Moving Allowance 20191015
Household Moving Allowance
State of South Dakota
When Application and Authorization sections
are completed, please submit the original to:
State Board of Finance
Office of Secretary of State
500 E Capitol Ave
Pierre SD 57501
Please check one:
State Transfer (SDCL 3-9-9)
Full-time continuous employment for 6 months.
Professional Recruitment (SDCL 3-9-12)
Attach a written copy of the offer of employment and of payment of
moving expenses.
PLEASE NOTE: The request and all supporting documentation must be received in the Office of the Secretary of State no
later than 5:00 p.m. CT eight days prior to the Board of Finance meeting on the third Tuesday of the month.
Documentation received after that time will be processed at the next Board of Finance meeting. All documentation MUST
comply with Bureau of Human Resources policies regarding protection of personally identifiable information.
Application
Name of Applicant New Position Title Agency Employed By
Yearly Salary City, State Moving From
Bureau of Human Resources Class Code
New Post of Duty (City) Expected Month/Year of Move
_________________________
Employment Date with the State
I hereby request authorization and approval to submit a voucher for reimbursement of actual household moving
expenses subject to the limitations established by South Dakota law. I shall attach to said voucher evidence of actual
household moving
expenses.
I understand that household moving allowance is considered taxable income according to IRS regulations, and I am
responsible for all applicable payroll taxes. I know I may contact my agency’s finance officer for options.
The undersigned agent hereby certifies that the above individual is employed in a full-time position with the above agency,
that the agency ordered the applicant to move as indicated, and that the move will be for the benefit of the State of South Dakota.
The Agent further declares that, to the best of the Agent’s knowledge and belief, the request and authorization for reimbursement
of actual household moving expenses are true and correct.
Position/ Title of Authorized Agent
Signature of Authorized Agent Date
Agency of Authorized Agent
Approval by State Board of Finance
Approved by the State
Board of Finance on
Signature of Secretary, State Board of Finance
