Chesapeake Public Schools

ITEMIZED STATEMENT
LOCAL TRAVEL FOR THE MONTH OF
Name:

Kaan Taylor

Social Security Numbe

Mailing Address:

July

2015

Position:

Student

School:

Edwards Wilson Center

3200 Morningside Dr
Chesapeake, Va. 23321
INSTRUCTIONS

1. Local travel is defined as travel in Chesapeake, Norfolk, Portsmouth, Suffolk, Virginia Beach, York County,
Williamsburg / James City County, Hampton, Newport News and Franklin.
2. Indicate starting point, final destination and all points between. If travel is to a non-Chesapeake Public Sc
facility, indicate purpose of the trip. Use more than one line if necessary.
3. Receipts should be attached for tolls when available. Attach explanation if receipts are not available.
4. Submit to appropriate central office department head during first week of following month.

Date

Nature of Expenditures and Purpose

Miles

Tolls

6-Jul

Two round trips to PSA from Morningside Dr

111.2

7-Jul

Two round trips to PSA from Morningside Dr

111.2

8-Jul

Two round trips to PSA from Morningside Dr

111.2

9-Jul

Two round trips to PSA from Morningside Dr

111.2

10-Jul

Two round trips to PSA from Morningside Dr

111.2

13-Jul

Two round trips to PSA from Morningside Dr

111.2

15-Jul

Two round trips to PSA from Morningside Dr

111.2

16-Jul

Two round trips to PSA from Morningside Dr

111.2

17-Jul

Two round trips to PSA from Morningside Dr

111.2

20-Jul

Two round trips to PSA from Morningside Dr

111.2

21-Jul

Two round trips to PSA from Morningside Dr

111.2

22-Jul

Two round trips to PSA from Morningside Dr

111.2

23-Jul

Two round trips to PSA from Morningside Dr

111.2

24-Jul

Two round trips to PSA from Morningside Dr

111.2

27-Jul

Two round trips to PSA from Morningside Dr

111.2

28-Jul

Two round trips to PSA from Morningside Dr

111.2

29-Jul

Two round trips to PSA from Morningside Dr

111.2

30-Jul

Two round trips to PSA from Morningside Dr

111.2

31-Jul

Two round trips to PSA from Morningside Dr

Amount

111.2

Summary of Totals:
2112.8 Miles at

2112.8

$0.445

Tolls

0
per mile

Grand Total

$940.20

###

Account Code

IApplicant
certify thatmust
the information
provided
on this
sign below.
CENTRAL
form is
correct. Assurance is given that all
reimbursement
requested is a result of expenditures incurred
conducting school business.
Date
Signature

OFFICE USE ONLY

To the Accounting Office:
The
undersi
gned
hereby
certifie
s that
this
request
for
travel
Date
reimbu
rsemen
tSignature
has
been
review
ed for
reasonablene
ss and
accura
cy, that
all
require
d

CS-116/R-93