Trans Code

PV
Acctg Mo.

TPV
PeriOO Adioo Type FurxI

VOUrnER DAlE

Mo

Day

Yr.

I Yr.

Travel Payment Voucher
TRANSMIT ORGINIAL AND ONE COPY TO FINANCE DEPARTMENT WITH REQUIRED RECEIPTS ATTACHED
Vendor Code

FUND NAME

I

~rig

n

~dj

1

GI

F

SCR PMf. DAlE OFF,
llA

Mo

Day

Yr.

TRAVELENCUMBERANCENUMBER

ACCT. PAID BY CHECK NO.

INCLUDE NAME OF ALL PERSON FOR WHICH EXPENSES ARE INCURRED IN THIS TRAVEL VOUCHER

Your name
Bureau Department

Your name Your address

Date

Description

Transportation

Lodging

Breakfast

Lunch

Dinner

Incidental Expenses (Explain)

Total

Totals I certify this Travel Voucher true and correct
DEPT Prepared by (Employee) BURFAU

D'istrilb ution .
OBJECf SUBORT

0 fCh

araes
AMOUNf lNa VOUCHERED DEe
PIF

BS. ACC'T

Bureau Head

Department Head - Approved for Payment

Director of Finance

Receipts must accompany the voucher covering transportation, lodging and incidental expenses. Cost of meals will be reimbursed in accordance with current travel policy. If an employee is required to use his private automobile, he will be reimbursed at the rate per mile stipulated in the current travel policy.

I