PART I.
BUDGET CODE:
No:
NAME:
TRAVELING TO:
DATE(S):
PURPOSE:
RECEIVED BY:
"FINAL SETTLEMENT DATE"
Amount of Advance:
Date Received:
PART II: ACTUAL EXPENSES INCURRED
TUITION AND REGISTRATION FEES $
LODGING (room and tax only)
COMMERCIAL TRANSPORTATION COSTS
TRANSPORTATION COSTS - TAXI, ETC.
MILEAGE - PERSONAL AUTOMOBILE: (MILES)
MEALS, TIPS & OTHER INCIDENTAL EXPENSES
gsa.gov
PROMOTIONAL AND ENTERTAINMENT COST:
(Restricted to City Manager, Coliseum, Convention & Visitor & Economic Development)
OTHER:
TOTAL EXPENSES $
SUBTRACT: AMOUNT OF ADVANCE
AMOUNT PAID BY CREDIT CARD
PREPAID BY SEPARATE INVOICE
BALANCE - check one
DUE CITY [ ] DUE EMPLOYEE [ ] $
I hereby certify that the above amounts are true and correct.
SIGNATURE DATE
Form No. 020-17 Rev 8 (11/16)
STATEMENT OF TRAVEL
(5 days after travel)