PRE-MOVE/HOUSE HUNTING EXPENSE WORKSHEET
Form must be completed and attached to Voucher, along with the
original Authorization for Moving Expense Reimbursement Form
and a copy of the Employment Contract .
Forward all documentation and original receipts which show method of payment
(Hotel/Motel receipts MUST show -0- balance) to Accounting Services, Stop# 8356
Please refer to the Accounting Services web site www.und.edu/dept/accounts for Moving Expense Policies and Procedures.
NAME of Employee
Last 4 digits of SOCIAL SECURITY NUMBER (Required for all US Citizens)
VISA TYPE (Required for Non-Resident Aliens)
PERMANENT HOME ADDRESS
CITY
STATE
ZIP
Pre-move/House Hunting Dates/Times
EXPENSES TO BE REIMBURSED: All expenses are taxable – Account Code 521055 1
MEALS: (per diem based on current in-state and out-of-state rate listings); Receipts are not required for meals
Rate
# of Meals
Total
Breakfast:
x
=
Lunch:
x
=
Dinner:
x
=
Meal Total
MILEAGE: Receipts are not required for mileage
Total Miles
Rate
x
Mileage Total
=
Lodging Total
LODGING:
AIRLINE:
Original passenger coupon or Electronic Ticket Invoice required.
MISCELLANEOUS:
Itemize each expense and applicable amount
Please use another sheet if needed
Original receipts required
Airline Total
Misc Total
TOTAL EXPENSES:
TOTAL AMOUNT AUTHORIZED:
I hereby certify this itemized statement representing a claim for per diem, mileage and moving expenses or combination thereof
is truthful and accurate. All expenses claimed have not been paid by the state through direct payments to the vendor or with a state credit
card and is not a duplicate payment.
______________________________________________________________________________________________________________
Employee Traveler’s Signature (in ink)
Date
1
Expenses limited to Employee & Spouse: Airline – 1 round trip / Lodging – 3 nights lodging / Meals – 3 days per diem /
Personal vehicle mileage– 1 round trip to new work location / Misc – Taxi, Parking / Car rental – 3 days
10/27/2010
University of North Dakota
MOVING PERSONAL GOODS EXPENSE/MOVING EXPENSE/
and/or PERSONAL TRAVEL EXPENSE WORKSHEET
Form must be completed and attached to Voucher, along with the
original Authorization for Moving Expense Reimbursement Form
and a copy of the Employment Contract .
Forward all documentation and original receipts which show method of payment
(Hotel/Motel receipts MUST show -0- balance) to Accounting Services, Stop# 8356
Please refer to the Accounting Services web site www.und.edu/dept/accounts for Moving Expense Policies and Procedures.
NAME of Employee
Last 4 digits of SOCIAL SECURITY NUMBER (Required for all US Citizens)
VISA TYPE (Required for Non-Resident Aliens)
ADDRESS MOVING FROM
CITY
STATE
ZIP
Moving Personal Goods Dates/Times
Moving Expense/Personal Travel Dates/Times
EXPENSES TO BE REIMBURSED: 2
MEALS: (per diem based on current in-state and out-of-state rate listings); Receipts are not required for meals Account Code 521055
Rate
# of Meals
Total
Breakfast:
x
=
Lunch:
x
=
Dinner:
x
=
Meal Total
MILEAGE: Receipts are not required for mileage, Account Code 521050 or 521055
Total Miles
Rate
x
Mileage Total
=
Lodging Total
LODGING: Account Code 521050
AIRLINE: Account Code 521050
Original passenger coupon or Electronic Ticket Invoice required.
MISCELLANEOUS: Account Code 521050
Itemize each expense and applicable amount
Please use another sheet if needed
Original receipts required
Airline Total
Misc Total
TOTAL EXPENSES:
TOTAL AMOUNT AUTHORIZED:
I hereby certify this itemized statement representing a claim for per diem, mileage and moving expenses or combination thereof
is truthful and accurate. All expenses claimed have not been paid by the state through direct payments to the vendor or with a state credit
card and is not a duplicate payment.
______________________________________________________________________________________________________________
Employee Traveler’s Signature (in ink)
Date
2
Maximum number of days for both travel time & temporary living quarters is 10 days
10/27/2010
University of North Dakota
TEMPORARY LIVING QUARTERS EXPENSE WORKSHEET
Form must be completed and attached to Voucher, along with the
original Authorization for Moving Expense Reimbursement Form
and a copy of the Employment Contract .
Forward all documentation and original receipts which show method of payment
(Hotel/Motel receipts MUST show -0- balance) to Accounting Services, Stop# 8356
Please refer to the Accounting Services web site www.und.edu/dept/accounts for Moving Expense Policies and Procedures.
NAME of Employee
Last 4 digits of SOCIAL SECURITY NUMBER (Required for all US Citizens)
VISA TYPE (Required for Non-Resident Aliens)
TEMPORARY LIVING ADDRESS
CITY
STATE
ZIP
Temporary Living Quarter Dates/Times
EXPENSES TO BE REIMBURSED: All expenses are taxable – Account Code 521055 3
MEALS: (per diem based on current in-state and out-of-state rate listings); Receipts are not required for meals
Rate
# of Meals
Total
Breakfast:
x
=
Lunch:
x
=
Dinner:
x
=
Meal Total
MILEAGE: Receipts are not required for mileage
Total Miles
Rate
x
Mileage Total
=
Lodging Total
LODGING:
AIRLINE:
Original passenger coupon or Electronic Ticket Invoice required.
MISCELLANEOUS:
Itemize each expense and applicable amount
Please use another sheet if needed
Original receipts required
Airline Total
Misc Total
TOTAL EXPENSES:
TOTAL AMOUNT AUTHORIZED:
I hereby certify this itemized statement representing a claim for per diem, mileage and moving expenses or combination thereof
is truthful and accurate. All expenses claimed have not been paid by the state through direct payments to the vendor or with a state credit
card and is not a duplicate payment.
______________________________________________________________________________________________________________
Employee Traveler’s Signature (in ink)
Date
3
Maximum number of days for both travel time and temporary living quarters is 10 days
10/27/2010
University of North Dakota