ACT-SEN O06 EXPENSE REPORT Name iracle $ibayon Department Gap (Cost Centr to be charged: ——, Date 2/17 (209% General Purpose of Travel Expense 2° quack Rio del aoe Fer Irons OWS __ Pe | j Gar amanTegerse [an oo ceed Tava ransponaton| Fo ern ate | (Cty 8County) [Fin aware Lotion | ts] suunen| Sues | Oewzetn | ammat | “Ener” | cranoroma, belut Mircet Oras | 20, 160 ley Rin, yA? Tang Tan Orv | Ven Ferar — Gh cs [ 359 TAL EXPENSES 72 THEREBY CERTIFY THAT ALL MATTERS CONTAINED IN’ THIS REPORT ADVANCES FOR LIQUIDATION ARE TRUE AND CORRECT. Date Reference “Amount ee Gens — , 21S) sr P fe less total approved expanses P_ 71S) 1 Daoe> balance due to Pig ————— ‘© Employee isin Hod ‘eon epatrent © Company Page__of_