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ArkCDA
Professional Expense Voucher |
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This form
and proper documentation must be submitted for reimbursement of expenses in
accordance with the ArkCDA Handbook. |
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Name |
Date |
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Address |
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EXPENSES |
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Travel |
TO |
From |
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Reason |
Miles (@48.5
per mile) |
Total Mileage
$ |
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*Lodging (Number of Nights) |
Total Lodging $
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Meals ($10 ea. Breakfast & Lunch,
$20 ea. Dinner) |
Total Meals $
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*Other (List) |
Total Other $
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*Attach Receipts |
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HONORARIUM (if applicable) Reason: |
Total Honorarium $
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TOTAL EXPENSES |
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SIGNATURE OF PERSON INCURRING
EXPENSE |
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OFFICE USE ONLY Check Number |
Date Paid |
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