Committee/Commission Reimbursement – POV News & Announcements

Committee/Commission

Please submit a separate voucher for each committee/commission.

Committee/Commission Name *

Name and Contact Information

First Name *

Last Name *

Email *

Mailing Address *

Mailing Address

City

State/Province

Zip/Postal

Meetings Attended

Date of Expense *

Purpose: *

Add Remove

Travel Expenses

Total No. miles traveled

Miles x 0.25

$

No. Additional Passengers

No. miles with passengers

Passengers x Miles x 0.03

$

Meal(s) and Lodging Expense

Please enter the totaled cost of meal and lodging receipts in the following fields, and then upload images of the original receipts. A maximum of 10 files may be uploaded. File types allowed are JPG, PNG, PDF, DOC and DOCX. You may include multiple receipts in a single image/scan.

Total Meal Cost

$

Total Lodging Cost

$

Upload Receipt(s)

Maximum file size: 5MB

Childcare Expense

Up to $10.00/hr for a maximum of 8 hrs.

No. of Childcare Hours

Childcare Cost/Hour

$

Other Expenses (Itemize)

Upload receipts using the upload field in the Meals/Lodging above.

Details of Expense

Amount of Expense

$

Add Remove

Reimbursement

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

Total Travel Expense

$

Total Other Expense

$

Subtotal

$

Less My Contribution

-$

Total Reimbursement

$

Captcha