FREDERICKTOWN LOCAL SCHOOL DISTRICT

 

Travel/Meeting Mileage Reimbursement Form

 

 

Name _________________________________        Approved P.O. No. ___________________

                        (Employee)

 

 

Date

 

Service Performed/Meeting Attended

 

Total Mileage

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                                                           TOTAL MILEAGE

 

 

 

                                                                         @ 40.5 cents/mile

                                                          TOTAL REIMBURSEMENT

 

 

Date _______________________________

 

Signature ___________________________              Approved by ________________________

                        (Employee)                                                                          (Supervisor)

 

 

Forms/Mileage Reimbursement-5/5/05