EXPENSE ACCOUNT STATEMENT
Employee: _
For period ending: _
REIMBURSABLE EXPENSES INCURRED
Hotel/Lodging $_
Meals $_
Tax $_
Travel (air, train, bus) $_
Personal auto _ miles x _ cents $_
Parking $_
Phone $_
Other (itemize):
_ $_
Total: $_
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I certify the above is a true statement of incurred
expenses in accordance with company policy. Receipts are
attached.
_______________________________
Employee
Approved for payment:
By:_____________________________