Monthly Mileage And Expense Report
MONTHLY MILEAGE AND EXPENSE REPORT
Made by ________________________________________________ Date ____________________________
Last 4 digits of Social Security No. __________________ For Month of _______________________________
Job Title ______________________________________ Work Site __________________________________
Date Description: From to Purpose Mileage Other
Expenses*
Amount Expense
Advance
*Meals, Bridge Toll, Parking, etc. Total Mileage ______________ Total Other $_________________
SACS#:
55¢ ______________ Total for Mileage $_________________
________________________________________
Control ________________
Certificated
Line # ________________
Classified
V # ________________
Management Total Expense Claim $ ________________
I hereby certify that the above is a correct and true statement of the actual and necessary expenses incurred by me in the
performance of official duties. I further certify that I carry personal vehicl e property loss and damage an d personal liability
insurance for any vehicle mileage expense claimed.
Examined and approved:
Date: _________________ _____ ___________________ ___________ ____ ___________ ___________ ______
(Claimant Signature) (Supervisor Signature)
Updated October 28, 2009
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