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<br />CITY OF LA PORTE <br />TRAVEL EXPENSE FORM <br /> <br />DEPARTMENT: <br /> <br />City Council <br /> <br />DEPARTURE DATE: <br />TIME: <br />RETURN DATE: <br /> <br />1~j6 J?k <br /> <br />December mileage reimbursement <br /> <br />EMPLOYEE NAME: Louis Rigby <br /> <br />DIVISION: <br />Purpose/Destination of Travel: <br /> <br />A. <br /> <br />TRANSPORTATION <br />1 Air Travel <br />2 Gasoline <br />3 Taxi <br />4 Car Rental <br /> <br />Check if item was prepaidIP-Card. list amount and deduct at the bottom of the page. <br />D <br />(For City Auto Only) D <br />D 0.00 <br />o <br /> <br /> Totals <br /> 5 Mileage (For Private Auto Only) 87.74 0.500 43.87 <br /> (To and From Airport) Miles Total <br /> 6 Parking @ 0.00 <br /> Days Rate Total <br />B. LODGING (All Hotel charges require an itemized bill) <br /> @ = 0.00 <br /> <br />Days Rate Total <br />o Check here if lodging was prepaidIP-Card. list amount and deduct at the bottom of page. <br /> <br />C. MEALS (MONEY RECEIVED AT PER DIEM RATE DOES NOT REQUIRE RECEIPTS) <br />(Did not receive any funds prior) Amount Received on Request 0.00 <br />NOTE: Meals should not be charged on P-Cards <br /> <br />. <br /> <br />D. REGISTRATION <br /> <br />E. <br /> <br />o <br />OTHERS <br /> <br />0.00 <br /> <br />Total <br />Check here if registration was prepaidIP-Card. list amount and deduct at the bottom of page. <br /> <br />Phone Calls <br /> <br />(Personal phone calls are limited to $5.00 per day) <br />All others - Must itemize and attach receipts <br /> <br />Total <br /> <br />0.00 <br /> <br />0.00 <br />Total <br /> <br />Gross Total: <br />Less amount charged to City P-Card <br />Less amount prepaid items <br />Less amount of Cash Advance <br />Balance due Employee if (Credit) <br />Balance due City of La Porte If Debit <br />THIS REPRESENTS THE TRUE AND ACTUAL TRAVEL EXPENSES OF THE AFOR <br />TRAVEL EXPENSE FORM. <br /> <br /> <br />~.\\ <br />0") <br /> <br />~ Signature is requftd to compIeIe this Form <br />EMPLOYEE SIGNATURE <br /> <br />DATE: <br /> <br />3-Jan-11 <br /> <br />Revised 01/09 Mileage Rate <br /> <br />DIRECTOR SIGNATURE <br />