| [FIRM NAME] |
| EXPENSE REIMBURSEMENT REPORT |
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| NAME: |
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EMPLOYEE NUMBER: |
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DEPT: |
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DATE: |
__________ |
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| Mileage - NOT chargeable to client - (if chargeable, it goes on a Client Expense Voucher) |
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Reimburs- |
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| Date |
Name of Client |
Purpose |
Destination/ |
Total |
Excluded |
able |
Parking |
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Location |
Miles |
Miles |
Miles |
& Tolls |
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- |
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TOTALS |
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| Reimbursable Mileage (@ 36c per mile) |
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| Parking & Tolls |
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TOTALS |
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ALL PAGES |
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| Total Reimbursable Mileage, Parking, & Tolls |
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'(6100.) |
| Professional Development (from reverse) |
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deductible portion |
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non-ded |
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50/100% |
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'(5240.) |
| Professional Membership (from reverse) |
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deductible portion |
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non-ded |
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50/100% |
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'(6120.) |
| Firm Development, Promotion & Entertainment (from reverse) |
deductible portion |
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non-ded |
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50/100% |
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'(5810.) |
| Miscellaneous (from reverse) |
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'( ) |
| Miscellaneous - other |
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'( ) |
| Total from Client Expense Voucher(s) (attached) |
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'(4010.) |
| TOTAL |
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$0.00 |
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| LESS: Travel Advance Dated: |
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Amount of Advance: |
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0.00 |
'(1410.) |
| TOTAL AMOUNT TO BE REIMBURSED |
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$0.00 |
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I certify that the expenses claimed and the supporting |
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documentation provided are true and correct. |
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APPROVED BY: _______________________ DATE: ____________ |
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| Front1 |
___________________________________ Date__________ |
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Signature of Payee |
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