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OufofStateTmvel Division Mgr <br />*qV <br />iv <br />Date: <br />Date: y • /T• ZdiO <br />Date: <br />Date: <br />BLUE areas only. Do not enter any information in the YELLOW shaded areas. - - ' / <br />rdirg mileage: Record your odometer before you begin your trip and when you reach your destination. Additional space is included for multiple uses. After your record your mileage, your <br />total reimbursement is automatically added in the'ReimbursemenC box. This will give you the <br />you will receive. DO NOT ENTER ANY INFORMATION IN THAT BOX. <br />e use per diem guidelines for meals. $39 per day for meals and $5 for incidentals. <br />are using a comparry credit card, please provide receipts. If you need a rash reimbursement, please provide receipts. If you are using per diem, no receipts are necessary, if you are <br />tracking expenses, no receipts are necessary. <br />CCC = COMPANY CREDIT CARD PCC = PERSONAL CREDIT CARD <br />OPC = OUT OF POCKET CASH PD = PER DIEM <br />.0 /G4!.?~~ <br />S0ANNE -P A <br />DATE: a' <br />INITIALS' <br />0/l-,qq-30 -&/7J1 <br />~2: <br />