Fillable Printable Monthly Mileage And Expense Report

Monthly Mileage And Expense Report

MONTHLY MILEAGE AND EXPENSE REPORT

Made by ________________________________________________ Date ____________________________

Last 4 digits of Social Security No. __________________ For Month of _______________________________

Job Title ______________________________________ Work Site __________________________________

Date Description: From to Purpose Mileage Other

Expenses*

Amount Expense

Advance

*Meals, Bridge Toll, Parking, etc. Total Mileage ______________ Total Other $_________________

SACS#:

55¢ ______________ Total for Mileage $_________________

________________________________________

Control ________________

Certificated

Line # ________________

Classified

V # ________________

Management Total Expense Claim $ ________________

I hereby certify that the above is a correct and true statement of the actual and necessary expenses incurred by me in the

performance of official duties. I further certify that I carry personal vehicl e property loss and damage an d personal liability

insurance for any vehicle mileage expense claimed.

Examined and approved:

Date: _________________ _____ ___________________ ___________ ____ ___________ ___________ ______

(Claimant Signature) (Supervisor Signature)

Updated October 28, 2009