10-25-10 Special Called Regular Meeting of Fiscal Affairs Committee

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CITY OF LA PORTE TRAVEL EXPENSE FORM EMPLOYEE NAME: Louis Rigby DEPARTURE DATE: TIME: RETURN DATE: TIME: DEPARTMENT: City Council DIVISION: Purpose/Destination of Travel: October 2010 Mileage Reimbursement A. TRANSPORTATION 1 Air Travel 2 Gasoline 3 Taxi 4 Car Rental Check if item was prepaid/P-Card, list amount and deduct at the bottom of the page. D (For City Auto Only) D D 0.00 D Totals 5 Mileage (For Private Auto Only) (To and From Airport) 423.4 Miles 0.500 211.70 Total 6 Parking @ Days Rate 24.00 Total B. LODGING (All Hotel charges require an itemized bill) @ 0.00 Days Rate Total o Check here if lodging was prepaid/P-Card, list amount and deduct at the bottom of page. C. MEALS (MONEY RECEIVED AT PER DIEM RATE DOES NOT REQUIRE RECEIPTS) (Did not receive any funds prior) Amount Received on Request 0.00 NOTE: Meals should not be charged on P-Cards D. REGISTRATION E. o OTHERS 0.00 Total Check here if registration was prepaid/P-Card, list amount and deduct at the bottom of page. Phone Calls (Personal phone calls are limited to $5.00 per day) All others - Must itemize and attach receipts Total 0.00 0.00 Total Gross Total: Less amount charged to City P-Card Less amount prepaid items Less amount of Cash Advance Balance due Employee if (Credit) Balance due City of La Porte if Debit THIS REPRESENTS THE TRUE AND ACTUAL TRAVEL EXPENSES OF THE AFOREME TRAVEL EXPENSE FORM. 235.70 0.00 0.00 0.00 (235.70). JA O/;Jdtl2d/() EMPLOYEE SIGNATURE ,/ Employee Signature is required to complete this Form DATE: Revised 01/09 Mileage Rate DIRECTOR SIGNATURE ()