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PAULDING EXEMPTED VILLAGE SCHOOLS
MONTHLY TRAVEL EXPENSE REPORT
NAME____________________________________
MONTH__________________________20_______
DATE
DESTINATION & PURPOSE
# MILES
Total Miles
X Current Rate
$.535
Total Mileage Expense
$
Misc. Expenses*
$
Total Reimbursement Due
$
*Please attach itemized receipts (with short explanation) for
Miscellaneous Expenses to upper left-hand corner.
Signature _____________________________________
Approval______________________________________
Form should be submitted by the 10
th
of each month following the expenses.