Travel Expense Statement Form

Traveler Information

KFS/Account #:
EBO TAR #:
Name:
Home Address:
Purpose of travel and destination:
Exchange rate: For international travel, please print and attach exchange rate information for applicable dates from https://www1.oanda.com/currency/converter/

Itinerary

Dates
Times
StartEnd
StartEnd
StartEnd
StartEnd
From
To
Private Auto Mileage*
*Please print and attach map route for private auto mileage claimed.

Travel Expenses by Date

Dates TOTAL
Breakfast** ($15.00)
Lunch** ($18.00)
Dinner** ($30.00)
Lodging
Taxi
Air
Rail
Bus
Auto Rental
Parking Fee
Bridge or Tolls
Telephone/Internet
Registration Fee
Private Auto Mileage* (calculated from itinerary): @ 0.655/mile
TOTAL EXPENSES:

*Private Auto Mileage Rates (65.5 cents/mile) (Note: 2022 TES forms will be paid at the old rate of 62.5 cents/mile):

A University employee using a privately owned vehicle for travel may be reimbursed for mileage. Mileage is measured from the closer of the duty station or point of departure to destination and return for travel on days during the employee's normal work schedule (weekdays). For travel on days that are not part of the employee's normal work schedule (weekends), actual mileage driven is reimbursable. Maps showing routes driven MUST be attached for reimbursement.

Remarks: