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AGENCY BUSINESS
UNIT
RSU Travel Form
Last Revised 01/09
CLAIM OF:
461
Employee ID/SSN:
STATE OF OKLAHOMA BUDGET ACCOUNT:
Travel Voucher
Address:
IN-STATE
OBJECT ACCT
AMOUNT
FOR
OUT-OF-STATE
OBJECT ACCT
AMOUNT
IS CAR GOV.
OWNED?
521110 Mileage
521210 Mileage
YES
521120 Per Diem
521220 Transp
NO
521130 Public Trans
521230 Per Diem
Agency, Bd.,
521140 Misc
521240 Local Trans
Comm., Dept.
521150 Lodging
521250 Misc.
LICENSE NO.:
$
AGAINST
ASSIGNMENT
521260 Lodging
I hereby assign this claim to
NON-EMPLOYEE
IS CLAIMANT A STATE
OFFICIAL OR EMPLOYEE? 521310 All Travel
and authorize the State Treasurer to issue a warrant in payment to
said assignee.
YES
Sub-Total
NO
$
OSF-Audited By:
OFFICIAL DUTY STATION:
Sub-Total
$
Total Amount
$
Claimant Signature
NATURE OF OFFICIAL BUSINESS:
Date
Show point travel status began, each point
visited and the point travel status ended.
(Vicinity only travel should show general
geographical area, e.g., Tulsa Vicinity)
Date
Mileage
Travel Status
Number
Claimed
Hour
of
Per-Diem
Year
2015
Mo.
Day
Map
Vicinity
Entered
Ended
Days
Hrs
Rate
TOTAL
PER DIEM /
LODGING
Lodging
Amount
Amount
TOTALS
TOTAL MILES @
$0.575
Per Mile =
MODE OF PUBLIC TRANSPORTATION
AGENCY DIRECT PURCHASE?:
ITEMIZED LOCAL TRANSPORTATION
If Yes, P.O. #:
TOTAL PUBLIC TRANSP.:
ITEMIZED MISCELLANEOUS COSTS
TAXI:
REGISTRATION FEE:
SHUTTLE:
TELEPHONE:
RENTAL CAR:
PARKING:
TOTAL ITEMIZED MISC.
OTHER LOCAL TRANSP:
TOLLS:
TOTAL LOCAL TRANSP.
OTHER MISC. COSTS:
I,
,
by signing here do under penalty of perjury, declare that the information
contained in this document and any attachments are true and correct to the
best of my knowledge and belief.
AGENCY DIRECT PURCHASE?
If Yes, P.O.#
(# of meals included in Registration)
TOTAL AMOUNT CLAIMED
Manager's Approval Signature
(If required)
Date
Other approval required (Director, Dean, V.P., President )
Date
I hereby approve this claim for payment and certify it complies with
Claimant Signature
Date
the travel laws of the State of Oklahoma.
Agency Approving Officer
Title
Date
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