Claim for Traveling Expenses

Name: Banner UID#: Dept: Phone:
PO No.: Blanket? Index No./Acct. Code: Period From: to
Campus Address (Home for Visitors):

A. EXPENSES PAID DIRECTLY BY THE CLAIMANT: SUBMIT ORIGINAL ONLY; (R)=RECEIPT REQUIRED
			TRANSPORTATION					OTHER EXPENSES
DATE	PLACE LEFT	PLACE ARRIVED	MILES	MILEAGE AMOUNT	AIRFARE (R)	LODGING (R)	MEALS & INCIDENTALS	EXPLAIN & ITEMIZE BELOW	TOTAL











TOTAL A:

COMMENTS

I certify this claim is true and all expenses were incurred on approved University business.

______________________________________
Claimant's Signature

_____________
Date

______________________________________
Resp. Official's/Designee's Signature

RO/Designee Name

_____________
Date

______________________________________
* Resp. Official's/Designee's Signature

RO/Designee Name

_____________
Date

(For expenses in Excess of PO amount)

______________________________________
Accounting Approval

_____________
Date


Prepared By (Please Print)	Email/Ext

B. EXPENSES PAID DIRECTLY BY THE UNIVERSITY
DATE	EXPENSE	AMOUNT
	AIRFARE (R)
	CONFERENCE (R)
	OTHER
TOTAL B:
*TRAVEL PURCHASE ORDER AMOUNT

TOTAL EXPENSE (Sum of A+B)
LESS PREPAID BY U of M (Subtract B)
LESS TRAVEL ADVANCE RECEIVED
PAYMENT DUE U of M
BALANCE DUE CLAIMANT