WHITEHEAD INSTITUTE

TRAVEL EXPENSE REPORT

Example for Non-Sponsored (Admin) Travel

  Do not complete shaded areas  
Date 4/28/02 TA Number Admin-3428
Traveler's Name
 Mary Jo
Dept/Lab Name Operations
Travele's Title
 Dir, Operations
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:
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  
    TOTAL TRAVEL EXPENSES:
$2,808.58 $1,813.58 $995.00  
          Less Cash Advance:
$0.00       
          Less Reimbursement by Third Party:
$0.00
         AMOUNT DUE TO TRAVELER OR ( WHITEHEAD):
$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
     
     
         Must match amount due to traveler or ( WHITEHEAD)--->
$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

Last Updated on 5/21/02
By User