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2015 CO Legislature Per Diem and Mileage Requests (3 of 4)
2015 CO Legislature Per Diem and Mileage Requests (3 of 4)
Total Requested: (ors Please use tie area for any comments or changes. Per Sen Veer r/poles- | ceaily thatthe statements In the above schedule are true and jst In all respects; that payment of the ‘amounts claimed neren hae not and wil nt be rembureed fo me fom any ater sources; hat my schedule of {fovel woe performed by ma on ofa Stata business and not for pereonal purposes: and that | actually ‘heated or pad the operating expenses ofthe rotor vehicle for which reimbursement is claimed ona mileage basis Payee: osSTATE OF COLORADO. GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO ‘January 2015 SENATOR SCHEFFEL Home to Capitol and Return St miles =~ @ — $082 $ 28.08 Payment Requested: Total Mileage: 17 Trips @ $ 28.08 s_477.36- Pan O/C ts en) sig STOR QULBe- Total Requested: 342ef>. Blo Please use this area for any comments or changes. | ceriy thatthe statements In the above schedule are tue and justin all respects; that payment of the ‘amounts claimed neteln hes not and wil not be reimbursed to me fom any oer souroes that my schedule of ‘fave wes performes by me on ofc Sate business and not for perSonal purposes, and that actually Ineured orale the operating expres fe rl velcly fr which veinbursernent i ckined on 2 nleage aa SoG pate: SE MASSTATE OF COLORADO GENERAL ASSEMBLY SESSION TRAVEL EXPENSE - METRO ‘January 2018 SENATOR STEADMAN Roundtrip Mileage: Home to Capitol and Return. 2miles <@ $ O52 § 1.04 Pao See = ease use this area for any comments or changes. | certify thatthe stalements in the above schedule are te and jst In all expects; that payment ofthe ‘amounts Calmed heren has not and wil not be rembursed tome fem any eter sources; hal my schedue of {ravel was perfommed by me on oficial Siate business and not for personal puposes, and that | actully \tcurred or pal te operating experns uf Ue inur veil Kar wih rembursement is claimed an a mloage baie‘STATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO January 2015 SENATOR TODD Roundtrip Mileage: Home to Capitol and Return 20 miles =@ © $ O82 $ 1040 Payment Requested: Total ieage: 1 ws @ $ 1040 s_L7¢.s0 Per Diem: les days @ 8 4500 sLOe0e ae *75Of- Total Requested: use this area for any comments or changes. | corty thatthe statements inthe above schedule are tue and just inal respects; that payment of the ‘amounts eimed heten has not and wal nat be reimbursed o me fom any cher sources; that my schedule of travel was performed by me on offeal State business and not for personal purposes; and that | actually Ineured or pal the opetaing expenses of ms motor vice for wnich reimburse cae eaeSTATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO January 2015 SENATOR ULIBARRI Roundtrip Mileage: Home to Capitol and Return %2 miles ~@ $052 $ 1255 Payment Requested: Total micros: | we @ $1288 $..2/3- Sb - reroiem: 29 dae @ $4500 3 LLPS00- 133.86 7 Total Requested: pespge Please use this area for any comments or changes. | cat tat the statements Inthe above schedule axe tue and jst i all respects; that payment of the ‘amounts claimed herein has not and wl ot be reimbursed o me fom any ther sources; hat my schedule of travel was performed by me on official Stato businoss and not for personal purposes, and that | actually Incurred or pate operating expenses of the motor vehicle for whch reimbursement is lamed on micage basisSTATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO January 2015 SENATOR WOODS Roundtrip Mileage: Home to Capitol and Return 27 miles @ $082 $ 1232 Payment Requested: micage: _/7 tos @ 8 1232 Ue Per Dior: Days @ 8 4500 Total Requested: Please use this area for any comments or changes. | catty thatthe statements in the above schedule are tue and justin al espects; that payment of the smourts claned herein has nol and wal nt be reimbursed to me from any other sources; hal my schedule of travel was perormed by me on ffeil State business and nat for personal purposes: and that | actly Ipaned or pou opetatng expenses che mot vele or nen emurtemusisamadon aisapeSTATE OF COLORADO ‘GENERAL ASSEMBLY o1 ‘SESSION TRAVEL EXPENSE - METRO February 2016 SENATOR AGUILAR Roundtrip Mileage: Home to Capitol and Return ‘mies @ $ 082 $ 884 Payment Requested: Total Micage: _i5 Tne @ 3 894 sLB0.00 pero _!% vas @ $4500 3.475700 847. 00 Total Requested: Please use this area fr any comments or changes. Sy 2 aa- a4] 1S se may be fete Uw lawns ~ | coy thatthe statamenis in the above schedule are true end justin al respects; that payment of the ‘amaunts ciamed heren has not and wl not be rembursed fo me fom any ater sources; that my schedule of travel was performed by me on official Slate business and nt fr personal purposes; and thet | ect ireumed opal the operating expenses of the motor vehicle fo whieh reimburcement is clamed on 2 mileage bass Ae Auta 2 Bho”STATE OF COLORADO GENERAL ASSEMBLY 02 SESSION TRAVEL EXPENSE - METRO February 2015 SENATOR BALMER Roundtrip Mileage: Home to Capitol and Return miles @ $052 $ 2184 Payment Requested: Total Requested: Please use ths area for any comments or changes. | cer thatthe statements Inthe above schedule are tue and justin all respects; that payment of the ‘amounts aimed herein hae nol and wil Not be rembursed to me fom anyother sources that my schedule of ‘ravel was performed by the on ofcial Sate business and not for personal purposes. nd that | actualy Incurred ot pel bw operaing expenses ofthe rotor vehsi or which rimbureaent le claimed on 2 mileage oss Og S Payee: _A SasaSTATE OF COLORADO. GENERAL ASSEMBLY 03. ‘SESSION TRAVEL EXPENSE - METRO February 2015 SENATOR CARROLL, Roundtrip Mileage: Home to Capitol and Return ‘Mamie @ $082 $ 1144 Payment Requested: 4 Teta sim — Mae iy Ay) ceroum 1A oop @ $4500 s fsSu00 Tan Beto) day - ofS00 er) ‘Total Requested: fe valor sou Fone ny ta Tl Ou ia dberak sede a Hath ond 8 dup 4 Pees | corty thatthe statements in the sbove schedule are true and justin al respects; that payment of the “amounts claimed heren has not and wil nol be rembused tome fom any other sources; that my schedule of ‘rave! was perfomed by me on offal Stale business and not for personal purposes; and tha | actually Treued or pall Ue opening expenses of the motor vehicle for which reimburzoment is caed ona mileage basis 42STATE OF COLORADO. GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO February 2015 SENATOR GUZMAN Roundtrip Mileage: Home to Capitol and Return mies —@ § 082 $ 416 pone eee mace le toh nse. 5 mwowm: IF cme sso + 8,0 g of 4 Total Requested: Pe | cetly tat the statements inthe above schedule are tue and jst in all respects that payment of tha ‘amounts claimed herein has nol and Wl ot be reimbursed to me rem any ater sources; that my schedule of travel wos perormed by me on offal Sata buries and not for personal purposes: and that | actually Incurred ot pad ie upetaliqy exseres of te motor vice or whch emburserent is clamed one mileage basis.‘STATE OF COLORADO GENERAL ASSEMBLY os: SESSION TRAVEL EXPENSE - METRO February 2015 SENATOR HEATH Roundtrip Mileage: Home to Capitol and Return. smiles @ — $ O52 § 29.12 Payment Requested: Tota Tips @ 8 2012 s SEPA Per Dame: Dae @ $4500 s £555 be Please use this area for any comments or changes, | cotty thatthe statements in the above schedule are tue and justin all respects; that payment of the ‘amounts aimed herein has not end wl nt be rembursed to me fom any other sources; thal my schedule of| Travel was performed by me on offical Slate business and not for personal purposes; and that | actualy Ineusred up he aperalony expenses OF the motor vehicle fr which rembursemet i lamed.on a mileage bose‘STATE OF COLORADO. GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO February 2015 SENATOR HODGE Roundtrip Mileage: Home to Capitol and Return ‘miles @ $082 $ 2892 Payment Requested: mierge: 11 ts @ — $ 02 sLEH-4G pordiem: 29 dae @ $4500 sL26080 LUE LE Total Requested: Please use this area for any commons or changes. | cetiy thatthe statements in the above sthedule are tue and justin al respects tat payment of the “amounts aimed herein has not and wi ot be rembursed tome fom any other sources; thal my schedule of ‘ravel was performed by me on offal Site business and not for personal purposes; and that | actly Ineured or pat ne operatng expenses of the motor venice for whieh reinsert cael aye bass, payee: _/Vaip WN 4 te Date:STATE OF COLORADO GENERAL ASSEMBLY o7 ‘SESSION TRAVEL EXPENSE - METRO Fobruary 2015 SENATOR HOLBERT Roundtrip Mileage: Home to Capitol and Return M8 miles —@ $082 $ 19:14 Payment Requested: Total maeage: [ties @ 5 11 3 303.04 ~ pene onvo neti e en eae = ie. Please use this area for any comments or changes. Adiptione | of per dicw Yor continent wootrngs , 2148. |ceriy that the statements in the above schedule ae true and justin all respects; that payment ofthe ‘caimed hein as not and wl at be eimbursed fo me fom any other sources. tha my schedule of perormed by me on ual lat buseress and not for personal purpases: and that | aca ineured er ld fhe operating expenses ofthe motor vehicle for winch rembursoment is claimed on @ mileage basi payer: (tls Havent Date: 02 ///S~‘STATE OF COLORADO GENERAL ASSEMBLY 08 ‘SESSION TRAVEL EXPENSE - METRO February 2015 SENATOR MARTINEZ HUMENIK Roundtrip Mileage: Home to Capitol and Return ‘Mimiles @ $052 $ 17.68 Payment Requested: miteage: _/7 32,2) “e FRG. PerDien: 22 Days @ s_990:00 Total Requested: SG sy eT gnade Bae pees % phe Mak) (fe | cerify thatthe statements in the above schedule ae rue and justin al respects; that payientof the amounts ‘aimed herein has not an wil not be celmbursed to me fom anyother sources; that my schedule of travel was pattommea by me on oficial State business sed Ht for persaral purposes; and that | actly incured or paid {he operating expenses ofthe motor vehicle fr which reimbursements cisimed on a mileage basis. a. owe: 02/7/15STATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO. February 2015 SENATOR JAHN Roundtrip Mileage: Home to Capitol and Return ‘miles @ $ 082 $ 884 Payment Requested: Total wicoge: 7 vie @ 5 884 5 Pervien: LS van @ $45.00 s.L2G0 0% L¢ID7-G6 Total Requested: s Please use this area for any comments or changes. | cory that he stalements In the above schedule are tue and justin all respects that payment of the ‘amounts aimed here has not and wil nl be rembursed fo me from any ater sources; hat my schedule of travel was performed by me on offal Sate business and not for personal purposes. and that | actly Incurred or pal! te operaltys experts of ne surveil Kx wih rnburernent is clomed on mileage baie Payee: om WaleSTATE OF COLORADO GENERAL ASSEMBLY SESSION TRAVEL EXPENSE - METRO February 2015 SENATOR JOHNSTON Roundtrip Mileage: Home to Capitol and Return 10miles @ $ O52 $ 520 Payment Requested: Total 14 tes @ $50 +_4bfo — perpen: 14 doe @ $4500 amas see e fO\e Total Request fa —/ Please use this area for any comments or changes, iteage: | catiy thatthe statements inthe above schedule are tus and justin all respects; that payment of the amounts claimed herein has not and wil not be reimbursed o me fom any oer source; that my schedule of travel was peroned by ma on offeal tate business and not for personal purposes; and that | actualy treured or paid me operating experses of he olor ylise fo wists ehiurseinei i claimed on a mileage sats / vome If owe: _ 2/2) |SSTATE OF COLORADO. GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO February 2015 SENATOR JONES Mileage: Home to Capitol and Return ‘miles ~@ = $ 082 § 2392 Payment Requested: micage: J tes @ 8 282 Perbiem: 24 ays @ $ 45.00 Total Requested: Please use this area for any comments or changes. | certify thatthe statements inthe above schedule are tue and jst in all respects; tat payment of the ‘amounts claimed here has not and wil not be reimbursed to me fom any eer sources; that my schedule of \favel wos pertormed by me on offal State business and not for personal purposes: and that | actualy \heurres or pa the operating expense of Ue lurve fx which renbursenent is clamed on a mileege ee Be 8 eeSTATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO February 2018 SENATOR KERR Roundtrip Mileage: Home to Capitol and Return ‘mmiles = <@ = $ 082 § 11.44 Payment Requested: otal meee OWirete asia Eun partion: 229 0m @ $4500 $10 35:20 Ll bebe : Total Requested: lease use this ares for any comments or changes. | cetily thatthe statements in the above schedule are true and jut a expects that payment of the amounts claimed heten has not and wil nat be reimbursed tome fom any other sources; that my schedule of travel wos performed by ma on offal State Business and not for personal puposes, and that | actly Ie pam eating expres Pee at ewer anan armies basis,STATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO February 2015 SENATOR NEVILLE Roundtrip Mileage: Home to Capitol and Return miles @ O82 $ 1382 Payment Requested: Total cage: |% tis @ 8 1382 8. gE Per Diem: 19 Days @ $ 45.00 8. SSS 00 LLL $s Total Requested: Please use this area for any comments or changes. | erty thatthe statements in the above schedule are rue and ust al respects; that payment ofthe amounts ‘Gained herein has not and wil not be reimbursed tome fon apy other sources; that my schedule of travel was fauna by tne on offcal Sate bvineee and not for perepfel purposes; and Pat | actualy incurred oF pak the operating expences ofthe motor vehicle for whi ret is claimed on a mieage basis. Payes Date:‘STATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO February 2015 SENATOR NEWELL Roundtrip Mileage: Home to Capitol and Return zmiles @ $ O52 § 11.96 Payment Requested: Total Mics: FO res @ $1196 $s. I27-2¢ Perdion: D5 vas @ $4500 $1125.00 13525 Total Requested: 8 i Ploase use this area for any comments or changes. | carly that te statements In the above schedule are tue and justin all respects; that payment of the ‘amounts cise heren has not and wil nt be reimbursed tome fom any other sources hat my schedule of {Tavel was performed by me on offi Sale business and not for personal pupposes, and that | actly ‘nour or paid the opeating expenses ofthe motor vehicle for which reimbursement is clare on @ mileage basis U Payee: A) leurl ae Sfafis‘STATE OF COLORADO. GENERAL ASSEMGLY ” SESSION TRAVEL EXPENSE - METRO February 2018 SENATOR SCHEFFEL Roundtrip Mileage: Home to Capitol and Return Smee Qk OaL 2808 Polit Ric bat Tou egies $583.52 atoiege ean foe ces $45.00 3859.00 266s Total Requested: s Please use this area for any comments or changes. | oetiy thatthe statements in the above schedule ave tue and jst inal respects; Vat payment of the ‘amounls claimed herein has not and Wl not be reimbursed o me rom any ater sources; that my schedule of travel was perfornes by ma on offal Stata business and not for pertonal purposes, and that | eet Insutrad or pal he operating expenses of te motor well for wis urement eames ot mila basisSTATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO February 2015 SENATOR STEADMAN Roundtrip Mileage: Home to Capitol and Return 2milee @ $ 082 $ 104 Payment Requested: eer eta Peres /s/Areelal Total Requested: Please use this area for any comments or changes. | cotity thatthe statements in the above schedule are ive and jst inal respects; that payment of the bmounts elaimod herein hes not and wil ot be reimbursed t me from any other sources; hat my schedule of travel was performed by me on offi Sate business and not for personal purposes; and that | actualy retired or pels mo opevalng expenses oe insur vei for mhich rembursement a clamed on 2 mileage basis,‘STATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO February 2046 SENATOR TODD Roundtrip Mileage: Home to Capitol and Return miles @ $ 082 § 1040 Payment Requested: wicase: | tips @ $1040 s LE 2.90 on: 18 oon @ 5 4500 s_8/0,00 Total Requested: Please use this area for any comments or changes. | cetty thatthe stalements in the above schedile are tue and justin a respects that payment ofthe ‘amounts claimed Neren has not and wl ot be rembursed io me fom any other sources; that my schedule of travel wos performed by me on oil Sata business and not for personal purposes. and that | actuallySTATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO February 2016 ‘SENATOR ULIBARRI Roundtrip Mileage: Home to Capitol and Return 242 miles @ © $ 082 $ 1258 Payment Requested: muoose: _!7 taps @ 8 1288 iretan 08 tap wl con Total Requested: Please use this area for any comments or changes. | cortty thatthe statenenis in the above schedule are tue and justin al respec; that payment of the ‘amounts claimed heren has not and wil not be reimbursed to me fem any othr sources; that my schedule of travel wes performed by me on offal Slate business and nat fr pereonal puposes; and tat | actualy Incured or paid the opeating expenses ofthe roto vaio for which reimbursement fs clamed ona rnieage basis. ) my QA iv vu Payee; wy JUL Ks pew: _ 3,STATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO. February 2015 SENATOR WOODS Roundtrip Mileage: Home to Capitol and Return 27 miles @ $ O82 § 1232 Payment Requested: Tota {A tins @ $s 1232 s_AZY.p8 — Perdiem: AU vas @ $45.00 3 F000 — Total Requested: Ploase use tie area for any comments or changes. am Working Monday, fb. | t part of 1 cory that the statements in the above schedule are tue and justin all respects; that payment of the ‘amounts claimed herein has rot and wil nl be reimbursed tome fom any other sources; hat my schedule of trove! was performed by me on ola Sate business and not for personal purposes; and that | actualy ‘noutted or aid the operating expenses ofthe motor vehicie for which remnbursement scam on mileage basie onSTATE OF COLORADO GENERAL ASSEMBLY on SESSION TRAVEL EXPENSE - METRO March 2015 SENATOR AGUILAR: Roundtrip Mileage: Home to Capitol and Return Vrms @. «$082 $ Payment Requested: Tot iitoage: _2O_ Tips @ S86 sL7¢ £0 EU Perdiem: _ AO vas @ $45.00 3_Qks IO Peb 23 of - 4500 Total Requested: sZvepo Poste use thi area for any comments or changes. 1 Sdn, =) ert | certify thatthe statements in the above schedule are true and justin all respects; that payment of the amounts claimed herein has not and will not be reimbursed to me from any other sources; that my schedule of travel was performed by me on offical State business and not for personal purposes; and that | actually incurred or paid the operating expences ofthe motor vehicle for which reimbursement is claimed on a mileage basis Paye BL ND pee DatSTATE OF COLORADO GENERAL ASSEMBLY 02 SESSION TRAVEL EXPENSE - METRO ‘March 2018 SENATOR BALMER Roundtrip Mileage: Home to Capitol and Keturn ‘miles @ $082 § 21.04 Payment Requested: we DO we ou rat: LD ome sm 3 /30S00 ea een aE Total Requested: 3 Please use this area for any comments or changes. ‘Mileage adjustment - February 23 (24.84) | certify thatthe statements in the above schedule are true and justin all respects; that payment of the amounts claimed herein has not and wil not be reimbursed to me fram any ather sources; that my schedule of travel was performed by me on offcil State business and not for personal purposes; and that! actually incurred or paid the operating expenses of is claimed ona mileage basiSTATE OF COLORADO GENERAL ASSEMBLY 03 ‘SESSION TRAVEL EXPENSE - METRO March 2016 SENATOR CARROLL Roundtrip mileage: Home to Capitol and Return zamiee @ $082 $ 1144 Payment Requested: Tota Wieage: AD tes @ = § 1m $27 OE reroten: A cae @ $4800 3990.08 allie Se caay | centity that the statements inthe above schedule are true and just n all respects; that payment of the ‘amounts claimed herein has not and wil not be reimbursed to me fom anyother sources; that my schedule of travel was performed by me on official Stata business and not for personal purpose; and that | actully Incurred or pad the operating expenses ofthe motor vehicle for which reimbursement i claimed ona mileage borisSTATE OF COLORADO GENERAL ASSEMBLY 04 ‘SESSION TRAVEL EXPENSE - METRO March 2015 SENATOR GUZMAN Roundtrip Mileage: Home to Capitol and Return Omiee §=@ $ 082 § 416 Payment Requested: mmiteage: 22 tips @ $416 seals < ease een ota a i Ue Total Requested: Please use this ares for any comments or changes. M a053 Wrateoaalpicstnent beetle f' le WV, n | celfy thatthe statements inthe above schedule are true and jus n all respects; that payment of the amounts claimed harain Rae not and will ote reimbursed to me fom any ather sources: that my schedule of travel was performed by me on offal State business and not for personal purposes; and that | actually incurred or paid the operating expenses ofthe motor vehi for which reimbursement is aimed on 8 mileage basis le oe Payee: pate: _9-/2 “Zor ¢—‘STATE OF COLORADO GENERAL ASSEMBLY os: ‘SESSION TRAVEL EXPENSE - METRO ‘March 2015 SENATOR HEATH Roundtrip Mileage: Home to Capitol and Return Sémiles @ $ O82 § 28:12 Payment Requested: Tota Mileage: Trips @ $ 2082 SLUe5e Per Diem: Days @ $45.00 $. (so february 2 Adusoment Sa Total Requested: Please use this area for any comments or changes. Mileage adjustment February 23 (28.2) | certify thatthe statements in the above schedule are true and justin all respects; that payment of the ‘amounts claimed herein has not and wll ot be reimbursed to me rom any ather sources that my Schedule of luavel was performed by me an official State business and not for personal purposes; and that I actualy incurred or paid the operating expenses ofthe motor vehicle for which reimbursement s claimed ona milage bassSTATE OF COLORADO (GENERAL ASSEMBLY os SESSION TRAVEL EXPENSE - METRO March 2015 SENATOR HODGE Roundtrip Mileage: Home to Capitol and Return amie $052 § 2392 Payment Requested: eat tos 2d We @ $ as 12 e Perbiem: _3\ Dm @ — $ 4500 sLBasi 08 February 23 Adjestment Total Requested: Please use this aea for any comments or changes. ‘uileage adjustment February 23 (23.52) | certify thatthe statements in the above schedule are trie and jst in all respects that payment of the amsntscsimad hacen has not and will othe reimbursed to me from any other sources: that my schedule of {ravel was performed by ine on offical State business and not for personal purposes; and that | actually Incutred oF pal the operating expenses of the motor vehicle fr which reimbursement is claimed ona mileage rare: Masha) Date: Sl ayig‘STATE OF COLORADO GENERAL ASSEMBLY o SESSION TRAVEL EXPENSE - METRO March 2018 ‘SENATOR HOLBERT ound Miaage: ee Con and sham seamen Qs Ose #1848 coma Total sage: Ties @ $190 ya This is, cx one-day mF re aawttBem BU om @ 5 4500 5 WHS February 23 Adustment 22 | > 1 so usa Total Requested: for! anfiur eel = save — Sees eer oe icetadsck thats ani Talclag ec, ae ames eid down ly one clay to companate Yor Aes closure AL = 1 BN, wiileage nek HILO FLM > tip) 94, | eonify thatthe statements inthe above schedule are true and just in all resoects: that aayment of the ‘amounts claimed herein has not and wil not be reimbursed to me fom anyother sources; that my schedule of travel was performed by me on offal State business and not for personal purposes; and tht | actully Incuced or paid the operating expenses ofthe motor vehicle for which reimbursement i aimed on a mileage boss, payee: Chis MaceaeT— Date: shale‘STATE OF COLORADO GENERAL ASSEMBLY SESSION TRAVEL EXPENSE - METRO March 2015 SENATOR MARTINEZ HUMENIK Roundtrip Mileage: Hometo Capitol and Retum (44-5 exebrcack 17) emiee —@ $052 § S785 S nchually aceite Be [8.24 Payment Requested: otal mong OR me $b rerdien: 2A tom @ — $ 4500 $990.00 ~ } exter 2 Op needs beg, Febrary2aadustment (322 hole bales ) “te peter 7220: hm RT sled 5 Total Requested: taeage adustment-Februsry23(17.66) QW _63 = actually hud to leaue We f (itn we HA Jaw to Hie Caprol'so wad, 2 | eotfy thatthe statements in the above schedule are true and justin all respects: that payment of the ‘mounts claimed herein has not and wil ot be reimbursed to me Kom any ather sources; that my schedule of travel was performed by me on official State business and not for personal purposes; and that | actually inured or paid the operating expenses ofthe motor vehicle for which reimbursements cleimed on 2 mileage oss‘STATE OF COLORADO GENERAL ASSEMBLY 09 ‘SESSION TRAVEL EXPENSE - METRO March 2045, SENATOR JAHN Roundtrip Mileage: Home to Capitol and Return ‘mies @ $082 $ 8.08 Payment Requested: Tota tone: 22 rigs @ 5 aan s SILLS reroem 3! ows @ — $ 4500 $1395.00 February 23 Adjustment s Seay [SOLE Total Requested: Please use this area for any comments or changes. Ileage adjustment February 23 8.88) | catfy thatthe statements in the above schedule ate true and justin ll vespets; that payment of the ‘mounts claimed herein has nota il ot be reimbursed to me from any other sources; that my schedule of travel was performed by me on official State business and not fo personal purposes; and that! actually incurred oF pa the operating expenses ofthe motor vehicle for which reimbursement is daimed ona mileage bos Payee:STATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO March 2015 SENATOR JOHNSTON Roundtrip Mileage: Home to Capitol and Return 1omiks @ $ 082 $ 5:20 Payment Requeste: a Tota ois @ $ 520 seo Perviem: ) vay @ $45.00 s_ ho ~ February 22 Adustment $_ so Total Requested: SzzDO Please use this area for any comments or changes. Mileage adjustment Febeuary 23 (5.20) | certify thatthe statements in the above schedule ate true and just in all respects; that payment of the amounts claimed herein has aot and wil not be reimbursed to me fram any other sources; hat my schedule of travel was performed by me on offal State business and not for personal purposes: and that | actually Incurred or paid the operating expenses ofthe tor vehi for which reimbursement is claimed on 2 mileage bass ASTATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO March 2015 SENATOR JONES Roundtrip Mileage: Home to Capitol and Return as mies §=@ = $ 052 $ 2392 Payment Requested: Tot woos _\G tee sus $ 3S: 50 perdi: Vv @ $4500 $ £21870 0 (x 73.50 Total Requested: $ Please use thie area for any comments or changes. | certify thatthe statements in the above schedule ate true and just in all respects; that payment of the mnunts claimed herein has not ond wil ot be reimbursed to me from any other sources; that my schedule of travel was performed by me on offical State business and not for personal purposas; and that I actually incurred or paid the operating expenses ofthe motor vehicle for which reimbursement i aimed ona mileage basi Payee: __f( @x/-/ f— Date: 2/ys‘STATE OF COLORADO GENERAL ASSEMBLY SESSION TRAVEL EXPENSE - METRO ‘March 2015 SENATOR KERR Roundtrip Mileage: Home to Capitol and Return mamilee @ $ 082 $ 1146 Payment Requested: Total teage: © tips © sone $ of rerun: ZB om @ $0 s 217000 1395.00 s Total Requested: Pease use tis area for any comments or changes. | certify that the statements inthe above schedule are true and just in all respects; that payment of the ‘mainte claimed herein Rac not and wil not be reimbursed to me fom anyother sources: that my schedule of travel wos performed by me on offal State business and not for personal purposes; and that | actually incutre or paid the operating expenses ofthe motor vehicle for which reimbursement is aimed ona mileage base. Ly thos Payee: Date:‘STATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO ‘March 2018 ‘SENATOR NEVILLE, Roundtrip Mileage: Home to Capitol and Return mies @ $ 082 $ 1382 Payment Requested: mieage: UD perviem: UL February 23 Adjustment Total Requested: Mileage adustment- February 23 (13.52) ‘ eamify thatthe statements inthe above schedule are true and just in all respects: that payment of the amounts claimed herein has not and wil not be reimbursed to me from anyother sources; that my schedule of travel was performed by me on official State business and not for personal purposes: and that | actualy incurred or paid the operating expenses of the motor vehicle fr which reimbursement is claimed ona mileage ass, A ae Cl Date: wis‘STATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO March 2015 SENATOR NEWELL Roundtrip Mileage: Home to Capitol and Return Bemis @ $082 $ 11.96 Payment Requested: Tota mieage; GX tips @ $ 96 sDBabr Perviem: 27 voy @ $45.00 $ L940 February 23 Adustment sey” ef bb SL Total Requested: s Please use thie area for any comments or changes. Mileage adjustment -February 23 (1196) | contify thatthe etatemante in the shove eche amounts claimed herein has not and wil not be reimbursed to me from any other sources; that my schedule of travel was performed by me on official State business and not for personal purposes; and that 1 actually incutre or paid the operating expences ofthe motor vehicle for which reimbursement x claimed ona mileage oe‘STATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO ‘March 2015 SENATOR SCHEFFEL Roundtrip Mileage: Home to Capitol and Return Sémiles = @ = $082 $ 28.08 Payment Requested: Tota Milesge: 2S trips @ $ 2808 s NTO Perdiem: 27 oa @ $4500 $940.00 February 23 Adjstment s_ wae) LE2D GF ‘ Total Requested: Ploase use tis area for any comments or changes. Mileage adjustment - February 23 (28.08) | contfy thatthe statements in the above schedule ate tr and jst in all respects: that payment of the amounts claimed herein has aot and wil nat be reimbursed to me fram any ather sources; that my schedule of teavel was performed by me on official State business and not for personal purposes; and tht | actually incurred or paid the operating expenses ofthe motor vehicle for which reimbursement is claimed on a mileage boas 0 Payee: Date: Sopa. /STATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO March 2015 SENATOR STEADMAN Roundtrip Mileage: Home to Capitol and Return 2miles @ $ 052 § 1.08 Payment Requested: ore er eat eed Oe ‘Total Total Requested: $ ree Pease use this area for any comments or cfanges. | certify hat the statements in the above schedule are true and just ia all respects; that payment of the amounts cmd herein he oot an will not he eimbwrend tome fram aay athe sees: hat my schedule of ‘rovel was performed by me on official State business and not for personal purposes; and that | actually Incurred or paid the operat basis pater (Zmerth 2015STATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO March 2015 SENATOR TODD Roundtrip Mileage: Home to Capitol and Return 20miee @ $ 082 $ 1040 Payment Requested: WA Total snag K tw @ 5 100 $27.20 j bays © $45.00 s_J/0. 60 99720 Total Requested: 5 Per Diem: Plaste use this area for any comments or changes. | certify that the statements in the above schedule are true and just in all respects; that payment of the ‘mounts caimed herein has nat and wil nt be reimbursed to me ftom any othor Sources; that my sched of travel was performed by me on offal Stote business and not for personal purposes; and that! actual incutred or paid the operating expenses ofthe motor vehicle for which reimbursements aimed on a mileage vs ere IE lSTATE OF COLORADO GENERAL ASSEMBLY SESSION TRAVEL EXPENSE - METRO. ‘March 2015 SENATOR ULIBARRI Roundtrip Mileage: Home to Capitol and Return M2 mils @ $$ 082 $ 1255 Payment Requested: eer ere fea a or aes aaa $1395,00 cots _ = Total Requested: Please use this aea for any comments or changes. ‘Miteage adjustment -February 23 (12.58) "cary thatthe statements inthe above schedule aro tre and juct i al respecte; that paymont ofthe ‘amounts claimed herein has not and wil not be reimbursed tome from anyother sources; that my schedule of travel was performed by me on offal State business and not for personal purpoces; and that | actually Incurced or paid the operating expenses ofthe motor vehi fr which reimbursement is aimed on a mileage bass \. pore: i Mn, Wi pate; 3] 12/15STATE OF COLORADO GENERAL ASSEMBLY SESSION TRAVEL EXPENSE - METRO March 2015 ‘SENATOR WOODS Roundtrip Mileage: Home to Capitol and Return 27 mies —@ $082 $ 1252 Payment Requested: mueage: 12) tips @ $ 1232 pervien: BA vo @ $ 4500 February 23 Adjustment Total Requested: Please use this area for any comments or changes. Mileage asjustment February 23 (1232) | certy thatthe statements in the above schedule are true and jut in all reepate; thot payment of the amounts claimed herein has not and wll ot be reimbursed to me from any ather sources that my schedule of travel was performed by me on offal State business and not for personal purposes, and tht | actually Incurred or paid the operating expenses ofthe motor vehce for which reimbursement clained on a ileage Hit Dh vedSTATE OF COLORADO. GENERAL ASSEMBLY SESSION TRAVEL EXPENSE - METRO April 2015 SENATOR AGUILAR Roundtrip Mileage: Home to Capitol and Return armies @ $ 052 $ 884 Payment Requested: Qi wes @ Peroiem: _ 21 vas @ Total Requested: Please use this area for any comments or changes. o1 | cory that the statements in the above schedule ate true and just in all respects: that payment of the ‘mounts caimed herein has not and wil ot be reimbursed to me from any other sources; that my schedule of travel was performed by me on offal State business and not for personal purposes; and that | actually incurred or pad the operating expenses ofthe motor vehi for which reimbursement i calmed on a mileage basis payee: lune Y- vate: 4. Mo: aory‘STATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO ‘April 2016 SENATOR BALMER Roundtrip Mileage: Home to Capitol and Return 42miles @ = $ 082 $ 21.84 Payment Requested: wings: Ql vie @ 5 at ruven: 20 om 0 $m Total Requested: lease use this area for any comments or changes. Mileage adustment-Februery 23 -2%-84}— | certiy thatthe statements inthe above schedule are true and just in ll respects: that payment of the amounts claimed herein has not and wil not be reimbursed to me fom any other sources; tat my schedule of travel wos performed by me on offal State business and not for personal purposes; and that | actully incurred or paid the operating expenses of the motor vehicle for which reimbursement is claimed ona mileage bass Payee: Date:‘STATE OF COLORADO. GENERAL ASSEMBLY 03 ‘SESSION TRAVEL EXPENSE - METRO ‘April 2015 SENATOR CARROLL ounatrip Mileage: Home to Capitol and Keturn mmies @ $ 082 $ 144 Payment Requested: wine: 2 ties @ rorom _A\ om @ Total Requested: Please use tis area for any comments or changes. Mucoge adjostment February 23448)— | certify that the statements inthe above schedule are true and justin all respects; that payment ofthe ‘ammounts claimed heels has not and wil nt be reimbursed to me from anyother sources; that my schedule of travel was performed by me on offal State business and not for personal purpores; and that | actualy incre or pai the operating expenses of the por vie for which eenburseren ced ona mileage basis AR) #2‘STATE OF COLORADO GENERAL ASSEMBLY 04 ‘SESSION TRAVEL EXPENSE - METRO April 2015 SENATOR GUZMAN Roundtrip Mileage: Home to Capitol and Return Smiles @ $ 082 $ 416 Payment Requested: Total Tin @ $6 sO7. 26 oy @ $45.00 s US od - Total Requested: 5 aa A Per Diem: rea for any comments or changes. | certify thatthe statements in the shove schedule ate true and justin all respects; that payment of the ‘amounts claimed herein has not and will ot be reimbursed to me from any athe sources that my schedule of travel was performed by me on official State business and not for personal purposes; and that | actually Incutre or paid the operating expenses ofthe motor vehicle for which reimbursements claimed on a mileage Paye ow: 4/14/2015‘STATE OF COLORADO ‘GENERAL ASSEMBLY os SESSION TRAVEL EXPENSE - METRO ‘April 2016 SENATOR HEATH Roundtrip Mileage: Home to Capitol and Return Semis @ «$082 zate Payment Requested: Tota Mileage: | tes @ $ saz sél/.s> Por Diem: Dn $ 45.00 sQY¥F0° 5BLS52 Total Requested: $ Pease se this area for any comments or changes. -atieoge sajstentFevraery23-¢2542), | cory thatthe statements inthe above schedule are true and just in ll respects; that payment of the “mounts clad haven hae not ant wil otha erento me fom any other sures; that my schedule of travel was performed by me on offical State business and not for personal purposes; and that! actully incurred at pad the operating expenses ofthe motor vehicle for which cembursement is lame ona mileage bad‘STATE OF COLORADO ‘GENERAL ASSEMBLY 06 ‘SESSION TRAVEL EXPENSE - METRO ‘April 2015; SENATOR HODGE Roundtrip Mileage: Home to Capitol and Return ‘miles @ = $ 082 $ 2282 Payment Requested: Tota Miewge: 2.1 Tis @ © § 2392 $409.52 PerDiem: 3) dae @ $45.00 $1390.00 lg s52:3> Total Requested: ¢ Please use this area for any comments or changes. ‘Mileogeadjustrent= PENTISTF23-425-90)~ | certiy thatthe statements in the above schedule are true and justin all respects; that payment of the ‘amounts calmed herein has not and wil not be reimbursed to me fom anyother Sources; that my schedule of travel wae performed by me on official State business and nat for personal purposes; and that | actualy incutred or paid the operating expenses ofthe motor vehicle for which reimbursement scam ona mileage ass.STATE OF COLORADO GENERAL ASSEMBLY o7 ‘SESSION TRAVEL EXPENSE - METRO April 2015, SENATOR HOLBERT Roundtrip Mileage: Home to Capitol and Return 368 miles @ $082 $ 10:44 Payment Requested: Tora iwage: Ll ins @ 5 1018 s_ 40-4 — reowm Ll ome smo — ¢_ 745-79 1340 44 Total Requested 5 Pease vse tis area for any comments or changes. sincere) € 1thaupit thet Hum wont, deve Rest ieess Reiss ot on ie verity Wook if decsn't hnppen. t= Thank pov. | cetfy thatthe statements in the above schedule are true and justin all respect; that payment of the amounts claimed herein has not and will not be ceimbursed to me from any other sources; that my schedule of ‘revel wor performed by me on offal State bucnece and not for prtonal purpeeet; and that # actualy incurred or pald the operating expences ofthe motor vehicle for which cenbursement is claimed on a mileage Es payee: _ Lorber T— Date: SLYo1S—STATE OF COLORADO GENERAL ASSEMBLY SESSION TRAVEL EXPENSE - METRO April 2016 SENATOR MARTINEZ HUMENIK Roundtrip Mileage: Home to Capitol and Return ‘Mmies @ $ 082 § 1 Payment Requested: ‘otal AL we 5 u0 3 Bl. a9 - Pee eo Ocha e Mit Total Requested: sEBie.28 — Please use ths area for any comments or changes. eager ststment—Fabraary-254-4%.685 | certify thatthe statements in the above schedule are true and justin all respects; that payment of the amounts csimed hersin hae not and wil not a reimburead toma fram any other sources; that my echadule of teovel was performed by me on offal State business and not for personal purposes; and tht | actually incurred or paid the operating expenses ofthe motor vehicle for which reimbursement iclakmed on a mileage ass Payee: =< Dates 9H /2-/S‘STATE OF COLORADO GENERAL ASSEMBLY 08 ‘SESSION TRAVEL EXPENSE - METRO ‘April 2045 SENATOR JAHN Roundtrip Mileage: Home to Capitol and Return ‘Tmiles @ $ 082 $ 886 Payment Requested: Total wane: Al tee § om SLI reriem 3D om @ — $ 4500 $1350.00 s a sf Total Requested: Ploase use this area for any commonts or changes. eage adjestment-February 234834) | certify thatthe statements in the above schedule are true and justin all respects; that payment of the ‘amounts claimed herein has not and wil not be reimbursed to me from any athe sourees: that my schedule of| travel was performed by me on offical State business and not for personal purposes; and that | actually Incuree or paid the operating expenses ofthe motor vehicle for which reimbursement is claimed on 8 mileage = ee vm HoSTATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO April 2015 ‘SENATOR JOHNSTON Roundtrip Mileage: Home to Capitol and Return ‘omiles ~@ § 052 $ 520 Payment Requested: itcage: | taps @ $520 Perdiem: | _ das @ $45.00 Total Requested: Ploase use this area for any comments or changes. lenge ahustnent—Febroary 23 5 20h | cenfy thatthe statements in the above schedule are true and just in all respects; that payment of the amounts claimed herein has not and wil not be reimbursed to me fom any ather sources; that my schedule of travel was performed by me on offical State business and not for personal purposes: and that! actualy inane or id te oat epenss of temo li wh enbrement ced on ge bass i PayeSTATE OF COLORADO GENERAL ASSEMBLY SESSION TRAVEL EXPENSE - METRO ‘April 2045 SENATOR JONES Roundtrip Mileage: Home to Capitol and Return mies = @ = $ 042 $ 2392 Payment Requested: seage ties @ $2392 Perdiem: D6 das @ $ 45.00 Total Requested: Please use thie area fr any comments or changes, | certify thatthe statements in the above schedule ate tr and just in all re amounts claimed herein has not and wil not be reimbursed to me from any other Total 8 BBLEE s 220.00 LOY ES specs; that payment of the sources; that my schedule of travel was performed by me on offal State business and not for personal purposes: and that | sctually incurred or paid the operating expenses ofthe motor vehicle for which reimburse bast Payee: ois a ment is climes ona mileage‘STATE OF COLORADO GENERAL ASSEMBLY SESSION TRAVEL EXPENSE - METRO April 2015, SENATOR KERR Roundtrip Mileage: Home to Capitol and Return ‘2milee @ $ 082 $ 1144 Payment Requested: muro: _Zef iee $ nae rerdiem ZS vas @ $ 4500 Total Requested: Please use this area for any comments or changes. | certify thatthe statements in the shove schedule are true and justin all respects; that payment of the amounts aimed herein has not and wil not be reimbursed to me ftom anyother sources: that my schedule of travel war performed by me on offal State business end not for personal purposes; and that | actualy incurred or paid the operating expences ofthe motor vehicle for which reimbursements caimed on a mileage basis‘STATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO ‘April 2015 SENATOR NEVILLE Roundtrip Mileage: Home to Capitol and Return mies @ $082 $ 1382 Payment Requested: Total $ 1352 $7 E3:-92- $ 4500 s_FY¥5.00 132 VG > s Total Requested: Please use this area for any comments or changes. ‘Mieage adjustment=Febnuacy 234352) | cory that the statements inthe above schedule are true and just in all respects; that payment of the ‘mounts laimed herein has nat and wil not be reimbursed to me fom anyother sources: that my schedule of travel was performed by me on offal State business and got for personal purposes; and that | actually incutred or paid the operating expenses ofthe moto vehicle for which reimbursement is clined ona mileage base‘STATE OF COLORADO GENERAL ASSEMBLY SESSION TRAVEL EXPENSE - METRO April 2015 ‘SENATOR NEWELL, Roundtrip Mileage: Home to Capitol and Return Zmilos ~@ = $ 082 $ 1196 Payment Requosted: eee Mere $ 1196 $2257: Me PerDiem: _& dap @ $45.00 8 1260.0 Total Requested: s Please use this area for any comments or changes. Mileoge abstment Februar 23 11.6) | certify thatthe statements in the shove schedule are true and justi all respects; that payment of the ‘mounts claimed hereln has not and will not be reimbursed to me from any athe sources: that my schedule of travel was performed by me on offal State business and not for personal purposes; and that | actually incutred or paid the operating expenses ofthe motor vehicle for which reimbursement is claimed ona mileage base payee: 05 biel Date:‘STATE OF COLORADO GENERAL ASSEMBLY SESSION TRAVEL EXPENSE - METRO ‘April 2015 SENATOR SCHEFFEL Roundtrip Mileage: Home to Capitol and Return Semis @ $ 052 $ 2808 Payment Requested: Tota wioage: Zio @ 5 2508 s DEFOE Perea et ee Tom s_GY¥srco Zt SBLOE Total Requested: Please use this area for any comments or changes, eng sistent Fabry 292686) | cory that the statements in the above schedule are true and jus in all respects; that payment of the amounts claimed herein has not and wl not be reimbursed to me from any other sources; that my schedule of Arava wes peshried by ane ox ciel Sate busines end mot for penal purpoees, and thet | ctaly ‘ncurced or paid the operating expenses ofthe motor vehicle for which reimbursement i aimed on a mileage baseSTATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO April 2015 SENATOR STEADMAN Roundtrip Mileage: Home to Capitol and Return 2milee @ $ 052 $ 108 Payment Requested: ae ieee aes eee. ea Peo 5 HST) Total Requested: $ ph Pease use this area for any comments or changes. | certify that the statements inthe above schedule are true and justin all respects; that payment ae ee esr te a eee er travel was performed by me on official State business and not for personal purposes; and that | actually Incurred or paid the operating expenses ofthe motor vehicle fr which reimbursement i claimed on a mlleage oe L one; Yagrcd 2015STATE OF COLORADO GENERAL ASSEMBLY SESSION TRAVEL EXPENSE - METRO ‘April 2015, SENATOR TODD Roundtrip Mileage: Home to Capitol and Return miles @ $ O82 $ 1040 Payment Requested: mioage: A | Tips @ $1040 portion: 3D om @ $45.00 Total Requested: se 0 5350 1565-40 ‘ Pease use this area for any comments or changes. | certify thatthe statements inthe above schedule are true and just n all respects; that payment of the amounts esimed hersin hot not ond wil not be reimburted to me fom any ether sources; that my chad of travel was performed by me on offal State business and not for personal purposes; and that # actully incurred or paid the operating expenses ofthe motor vehicle for which reimbursement i claimed on 3 mleage basis:STATE OF COLORADO GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO ‘April 2015, SENATOR ULIBARRI Roundtrip Mileage: Home to Capitol and Return 22 mile @ § 082 § 12.58 Payment Requested: Tota misoge: Qs @ 5 1258 8a2GAIE reroum 30 om @ 5 4500 $1350.00 LLL Total Requested: Please use this are for any comments or changes. MicogeasSenn=FaBMRG ZTE) "certify thatthe statements in the above schedule are true and just in all respects; that payment of the amounts clsimad herain hat aot and will not be relmburd to me from any athor2ourses; that my sthedule of teavel was performed by me on offi State business and not for personal purposes, and tht | actually Incurred or paid the operating expenses ofthe motor vehicle for which reimbursement claimed on a ileage core. A WM. Um pate: 4 /(41‘STATE OF COLORADO GENERAL ASSEMBLY SESSION TRAVEL EXPENSE - METRO. April 2015 SENATOR WOODS Roundtrip Mileage: Home to Capitol and Return ZT miles =@ $082 § 12:32 Payment Requested: Total Requested: leage adjustment —Febeusey 23 232}~ | certiy that the statements in the above schedule are rue and justin all respects; that payment of the ‘mounts claimed herein hea not and wil note reimbursed to me fom any athe sous, Travel was performed by me on ofl State business and nat for personal purposes; and that | actually Incurred or pal the operating expenses of the mater vehicle for which reimbursement s claimed ona mileage as‘STATE OF COLORADO ‘GENERAL ASSEMBLY ‘SESSION TRAVEL EXPENSE - METRO May 2015 SENATOR AGUILAR 1 Roundtrip Mileage: Home to Capitol and Return ‘7miles @ § O52 $ B84 Total Requested: Please use this area for any comments or changes. Tota 3_ 35-3 s1f0.00 W536 $ | colfy thatthe statements in the above schedule ere true and justin al respects; that payment ofthe amounts caimed herein hi not and wil othe crmburn ome fen anyother Sources: that my schedule of travel was performed by me on offi State business and nat for personal purposes; and that | actually Incurred or paid the operating expenses ofthe motor vehicle for which reimbursement is claimed ona mileage basi Payee: pate: _ S/b [15