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["EXPENSE REPORT"]
["Submitted by:__________________________________",{"$nulls":5},"Department:__________________________________"]
[]
[]
[null,"______ Request for Reimbursement of Expenses"]
[]
[null,"______ Accounting for an Expense Advance Received"]
[]
["Purpose of Expenditure: ______________________________________________________________________________"]
[]
["____________________________________________________________________________________________________"]
[]
["Date","Description (Please use one line for each receipt - attach additional sheets if necessary)",{"$nulls":7},"Amount"]
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["Check Payable to:",{"$nulls":5},"Total Amount of Receipts:"]
[]
["Date:",null,"SS or ID No.:",null,null,null,"Less Expense Advance:"]
["Account No. to be Charged:"]
["Approval of Divisional Vice President:",{"$nulls":5},"Less Other:"]
[]
["Business Office Certification:",{"$nulls":5},"Total Amount Due:"]
[]
["INSTRUCTIONS: Account number to be charged must be inserted; Travel by auto reimbursable at $0.55 per mile - show points of travel and milage daily; Attach receipts for all hotel bills, railroad or plane fares, taxi's, tolls, meals, tips, etc…; If entertainment - show name(s) of person(s) and reason for entertainment under \"Purpose of Expenditure.\"                                                                        Revised January 2009"]

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