Good Spirit School Division Reference Administrative Procedure 517 Page 1 of 1 Effective 03-Nov-10

Form 517 1

REIMBURSEMENT OF EXPENSE FORM (To be submitted to Accounting Department)

Name Date Address Position School/Dept. Purpose of Expenditure

Travel Expenditures

Travel Dates: From to

Travel Mileage: X /km

Note: Regular mileage rate: /km

When car pool opportunities exist: Full Rate (3 or more) - /km

(List passenger(s) below please) Rate (2 in vehicle) - /km

Rate (1 in vehicle) - /km

Passenger(s):

Accommodation: (choose one)

Hotel/Motel (attach receipts) OR Private Residence $25.00/night

Meals: Breakfast X

Lunch X

Supper X

Other Purchases: (specify and attach receipts)

TOTAL EXPENSE REIMBURSEMENT:

Signature of Applicant Date

Signature of Authorized Supervisor/Position Date

G.L. Account Number

topmostSubform[0]: Page1[0]: Name[0]: Thad SwidzinskiDate[0]: Dec 4Address[0]: 21 Deerwood CrescentPosition[0]: DLCSchoolDept[0]: Purpose_of_Expenditure_1[0]: Equipment for Distributed LearningTravel_Dates_From[0]: to[0]: Travel_Mileage[0]: Travel_KM[0]: Total_Mileage[0]: Passengers[0]: Hotel_Total[0]: Breakfast[0]: Lunch[0]: Supper[0]: Total_Breakfast[0]: Total_Lunch[0]: Total_Supper[0]: Other_Purchases_specify_and_attach_receipts_1[0]: Other_Purchases_specify_and_attach_receipts_2[0]: Other1[0]: Other2[0]: undefined_3[0]: Date_2[0]: Date_3[0]: GL_Account_Number[0]: Breakfast_Rate[0]: $15.00 Supper_Rate[0]: $25.00 Lunch_Rate[0]: $20.00 MileageRate[0]: 0.42FullRate[0]: 0.420 SupperRate[0]: 0.1050 HalfRate[0]: 0.210 TextField1[0]: 07-Nov-14Private_Residence[0]: 50.00