Online Assembly Voucher Form – POV News & Announcements

In order to be eligible for Travel Expense reimbursement, your name must appear on the assembly sign-in sheets.

Name & Meeting Attended

First Name *

Last Name *

Date of Meeting

Contact Information

Email *

Mailing Address *

Mailing Address

City

State/Province

Zip/Postal

Travel Expenses

Total No. miles traveled

Miles x 0.25

$

No. Additional Passengers

No. miles with passengers

Passengers x Miles x 0.03

$

Parking Expense

$

Contribution

Please deduct from the total travel expense the following sum, which I am hereby making as a contribution to the Presbytery of Ohio Valley.
(The amount of your contribution will be included on your year-end giving statement.)

Amount of Contribution

$

Reimbursement

If you are donating any of your expenses, add the amount in the “Contribution” field above.

Total Travel Expense

$

Less My Contribution

– $

Total Reimbursement

$