Master Agreement 2005 - State Employment Relations Board

Transportation Reimbursement Form
Name
COLUMBUS PUBLIC SCHOOLS
LOCAL TRANSPORTATION REIMBURSEMENT REPORT
Period Covered: From ______ Through
SchooVOept.
-------- Check Location
Purchase Order II ----------
Vendor II _________________ _
Trip Report
~ _F"~_ To
Mllea ~=g
TOTAL MILES
X CURRENT MILEAGE RATE
AMOUNT TO Bl! REIMBURSED
~
I hereby certify that the mileage and parking shown above (1) are
correct; (2) were incurred in the discharge of business for the Columbus
Public Schools; and (3) have not previously been reimbursed.
Signature SSN
Approved By Date
Cat. H003II6 (R