Employee Reimbursement Form - Kansas
Updated 1/7/11
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City:
Employee Reimbursement Form
I purchased the following items or services for use by the University of Kansas, and am seeking reimbursement. All l isted
purchases are now University property, and I no longer have any ownership of the purchases listed. The listed purchases are
not being reimbursed with other University funds or any outside entity. All original receipts are submitted. I fully understand
the entire reimbursement may be denied if proper procurement procedures were not followed.
Description of Purchase
Amount
State:
ZIP:
Employ ee Name:
Address:
Employee Signature
Date
Total
Signature of Person Authorizing Reimbursement
*
*May not be same as employee being reimbursed
Date
Title
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