From: To:
City Vehicle
Date
Private Auto 10) Advance Pay Requested
Finance- Funds Approval
Date
Air Yes No
City Administrator
Date
Other If yes, complete below
Pre Event Post Event
Total
-$ -$ -$ -$ -$ -$
-$ -$ -$ -$ -$ -$
-$ -$ -$ -$ -$ -$
-$ -$ -$ -$ -$ -$
-$ -$ -$ -$ -$ -$
-$ -$ -$ -$ -$ -$
-$ -$ -$ -$ -$ -$
* (Tips cannot exceed 15% of total meal costs)
-$ -$ -$ -$ -$ -$
# miles Per mile
-$ -$ -$ -$ -$ -$
-$
** Date Needed
23) Amount Prepaid (including Credit Card) -$ Date
24) Reimburse expense to employee -$
Date
21) Total
Department Head
25) I certify that the foregoing expenses were incurred in the conduct
of business and for payment of such are available in the current
budget.
Employee
17) Registration Fee
18) Meals (see per diem schedule)
20) Mileage(private auto)
19) Misc (Specify)
(Prior to trip, list actual expenses each day- Attach receipts/prepaid expenses from above- list on first day)
(If any expense below is paid for by City credit card- show on this report and add amount(s) to Amount Prepaid total on bottom of page)
12) Dates
13) Lodging
14) Garage/Parking
15) Taxis/Car Rental
16) Transportation
8) Method of Travel
9) Total Estimated Cost of Trip
11) Approval
Department Head
6) Destination
7) Dates
PART I - TRAVEL REQUEST
1) Name
2) Department/Division
3) Date
4) Purpose of Trip (name of meeting, reason for travel, job relation)
5) Account Number(s)
22) Amount to be prepaid to employee
PART II - EXPENSE REPORT
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0.00
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$ 0.575
0.00
0.00
0.00
0.00
0.00
0.00
0.00
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Please see the City of Stephenville Personnel Manual for full details of the travel and reimbursement policy
THINGS TO REMEMBER:
Travel Per Diem Rates: $50 per day
Travel Per Diem Rate for Partial Days:
Breakfast
$10.00
Lunch
$15.00
Dinner
$25.00
Meals that are provided as part of a conference, training, etc. are not covered by per diem and should be
subtracted from a per diem request according to the schedule above
***All receipts for purchases over $5.00 is required with the exception of tips which must be 15% and
under***
Online map calculations that show distances may be used for mileage logs.
Appendix E
Form 15
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