Voucher Claim Form - Business Services

MASSENA CENTRAL SCHOOL DISTRICT
VOUCHER CLAIM FORM
DATE:
CLAIMANT NAME:
ADDRESS:
SS# OR FED ID#
Vendor #
Fund: Please CIRCLE One
A - General
B - Bookstore
C - Cafeteria
F - Special Aid
- Capital
SA - Student Activity
T - Trust & Agency
BUDGET CODE:
H
DATE OF SERVICE QUANTITY UNIT PRICE AMOUNT
DESCRIPTION
TOTAL
Claimant's Certification: This is to certify that the materials and/or services charged and included in the above claim have been actually
performed for, furnished and/or delivered to the above named Board of Education; the charges therefore are true and just, and that no
payments have been made on this claim to date.
Date
Signature of Claimant
APPROVALS:
Principal/Director:
PLEASE RETAIN A COPY FOR
YOUR RECORDS
Business Administrator:
Student Activity Treasurer:
Student Activity Advisor:

Voucher Claim Form Instructions
The voucher claim form must be completely filled out with a claimant name, address, date of
transaction, account code, description and cost.
This form must be used for reimbursement of expense requests. Voucher claim forms must not be
used to circumvent the purchasing policy.
We have purchasing policies and procedures in place. These must be adhered to; all expenses must
comply with bid processes, policies and procedures of the District.
Prior authorization from a Principal or Director must be obtained prior to incurring an expense.
Reimbursement will not be made without prior approval. The use of this voucher claim form for
reimbursement of goods and services already purchased must be limited to use only after all other
attempts to use a purchase order have been exhausted.
Reimbursements for expenses must be done within 30 days from purchase and event.
Please feel free to ask questions prior to incurring an expense. This will clarify spending and ensure
reimbursement.
TRAVEL REIMBURSEMENTS
• Meal expenses will be reimbursed based on the following per diem rates:
Breakfast $10.00
Lunch $15.00
Dinner $25.00
• All expenses must be supported by an itemized receipt (a credit card receipt will not be sufficient).
• Alcoholic beverages, gratuity, taxes, and entertainment will NOT be reimbursed.
• Mileage reimbursement must include: destination (to and from), specific travel dates, purpose of trip
and number of miles.
• Reimbursable mileage may be submitted on a quarterly basis. All mileage requests must be
submitted by June 15 of the given fiscal year. Our fiscal year is July 1 to June 30.
• Itemized hotel bills are required.
• We are a governmental unit and are tax exempt. Tax exempt certificates are available in the
Business Office.