2:125-E1 Board Member Expense Reimbursement Form
Submit to the Superintendent, who will include this request in the monthly list of bills presented to the School Board. Please print and attach receipts for all expenditures. Use of this form is required by 2:125-E3, Resolution to Regulate Expense Reimbursements. Please print.
Name:
Title/Office:
Travel Destination:
Purpose:
Departure Date:
Return Date:
Receipts attached Request Date:
Approved expense advancement (voucher) attached, if applicable* (Completed 2:125-E2, Board Member Estimated Expense Approval Form.)
| Actual Expense Report
* Board members will be reimbursed for actual and necessary expenses that exceed the amount advanced, but must refund any expense advancement that exceeds the actual and necessary expenses incurred. (105 ILCS 5/10-22.32) |
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| Auto Travel Allowance: per mile | ||||||||||
|
Date |
Mileage
Miles Cost |
Comm.
Travel Expenses |
Lodging |
Meals
Bkfst | Lunch | Dinner |
Other
Item Cost |
Daily
Total |
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| Subtotal | ||||||||||
| Advances | – | |||||||||
| TOTAL (a negative amount indicates refund due from Board member) | $ | |||||||||
Submitting Board Member’s Signature: _________________________________
Date: ________________________
Superintendent Signature: ___________________________________
Date: _______________________
School Board Action (circle one):
Approved Denied
Approved in Part Exceeds Maximum Allowable Amount
Date Adopted: December 20, 2016
