WHITEHEAD INSTITUTE
TRAVEL EXPENSE REPORT
Example for Non-Sponsored (Admin) Travel
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Do
not complete shaded areas
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| Date | 4/28/02 | TA Number | Admin-3428 | |||||||||
| Traveler's Name |
Mary
Jo
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Dept/Lab Name | Operations | |||||||||
| Travele's Title |
Dir,
Operations
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Dept/Lab Contact Person | Same as traveler | |||||||||
| Traveler's Home Address | 1234 Babcock St | WI Phone No | 8-4444 | |||||||||
| Somerville , MA | Send payment to (if other than Traveler's address): | |||||||||||
| Trip purpose and Destination | Lawson User Conference/ San Antonio Texas | |||||||||||
| EXPENSES - Include ONLY Expenses that will be Reimbursed per Travel Policy | ||||||||||||
| DATE | DESCRIPTION | $ Paid by Traveler | $ Prepaidby WIBR | Receipt Number | ||||||||
| TRANSPORTATION (To/from, mode, rental fee, parking fees, tolls, etc.) | ||||||||||||
| 4/20 and 4/25 | Airfare Boston-San Antonio - Boston | 404.50 | 1 | |||||||||
| 4/20 and 4/25 | Shuttle Airport - Hotel - Airport, San Antonio | 17.00 | 2 | |||||||||
| MilesDriven: | Rate: | 0.365 |
Mileage
Reimbursement:
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0.00 | ||||||||
| TRANSPORTATION TOTAL | $421.50 | $0.00 | ||||||||||
| LODGING (Hotel Name) | ||||||||||||
| 4/20-4/24 | Marriott Riverwalk | 1,301.75 | 3 | |||||||||
| LODGING TOTAL | $1,301.75 | $0.00 | ||||||||||
| MEALS AND BEVERAGES (Type of Meal) | ||||||||||||
| 4/20/02 | Dinner with Brian Smith (I paid for both) | 33.62 | 4 | |||||||||
| 4/24/02 | Dinner with Jan Cohen (we split bill … she will submit copy of receipt) | 32.40 | 5 | |||||||||
| 4/20/02 | Lunch on Travel Day - O'Hare | 7.64 | 6 | |||||||||
| 2/25/02 | Lunch on Travel Day - O'Hare | 7.09 | 7 | |||||||||
| 4/21/02 | Lunch @ Hotel - "Cactus" | 9.58 | 8 | |||||||||
| MEALS AND BEVERAGES TOTAL | $90.33 | $0.00 | ||||||||||
| REGISTRATION FEES AND OTHER MISCELLANEOUS EXPENSES | ||||||||||||
| paid in advance -- confirmation of registration and payment attached | 995.00 | 9 | ||||||||||
| OTHER T0TAL | $0.00 | $995.00 | ||||||||||
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TOTAL
TRAVEL EXPENSES:
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$2,808.58 | $1,813.58 | $995.00 | |||||||||
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Less Cash Advance:
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$0.00 | |||||||||||
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Less Reimbursement by Third Party:
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$0.00 | |||||||||||
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AMOUNT
DUE TO TRAVELER OR ( WHITEHEAD):
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$1,813.58 | |||||||||||
| FUNDING | ||||||||||||
| If it is not appropriate to split all charges among the activities identified below, please submit backup identifying specific charges to specific activities. | ||||||||||||
| ACTIVITY NUMBER/NAME | ACCOUNT CATEGORY/NAME | AMOUNT | ||||||||||
| 01-0010-0101 Grants & Acctg | 6005 Domestic Travel | $1,813.58 | ||||||||||
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Must
match amount due to traveler or ( WHITEHEAD)--->
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$1,813.58 | |||||||||||
| REQUIRED SIGNATURES/APPROVALS | ACCOUNTING USE ONLY | |||||||||||
| Traveler's Signature (1) | Date | DATE:________ | INVOICE #_____ | |||||||||
| Department/Lab Approval (2) | Date | VOUCHER # __________ | ||||||||||
| Grants/Business Office Approval (3) | Date | ENTERED BY: ____________ | ||||||||||
| (1) Indicates that the information provided is correct, proper receipts are included, and expenses claimed comply with policy. | ||||||||||||
| (2) Indicates that expenses claimed comply with policy, and funds are available to cover the expenses | ||||||||||||
| (3) Indicates that expenses claimed comply with policy, expenses are charged to the proper activity/account category, and receipts are included | ||||||||||||