Last Name     First Name Department   Year Employee Number
Expenses Paid by Employee                    
Date     Client Description of Expenses Miles Travel Hotel Food Entertain. Other Account
Month Day Wday   (Nature of Expense)   (Tolls, Park)          
      $ per mile 0.296  
      Total mile     Total Expenses
              Temporary advance
              Amount due
I hereby certify that the above expenditures were spent for legitimate Company business only and include no items of a personal nature.
Signature     Date   Approved By       Date  
  Receipts must be attached for all expenditures.