Rotary District 5130 Expense Reimbursement Request
Step 1 of 2: Submit
The District acknowledges that Rotarians may experience out-of-pocket expenses while conducting District business or leading training sessions. Each committee and event may build into their budget amounts to reimburse these expenses with the following rules:
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Mileage
will be allowed at the current IRS rate if the distance traveled is over 100 miles one way. Mileage may be documented using a map program such as MapQuest or by a log entry of beginning and ending mileage (with no extraneous mileage).
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Airfare
will be the economy rate and no seat upgrades, meals, or travel insurance.
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Hotels
are basic queen/king bedrooms. No room service, no pay per view, no laundry. Bell tips OK.
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Meals
shall be reimbursed at a reasonable actual expense (no alcohol).
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Parking, shuttles, ground transportation, etc.
shall be the most economical method available.
Expense reimbursements are paid on the 20th of the month. Please submit all requests within 30 days of the expense occurring.
Date
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Name of Person Making Request
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Role of Person Requesting Expense Reimbursement
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Select an option:
District Governor
District Governor Elect
District Governor Nominee
District Governor Designate
Past District Governor
District Treasurer
District Secretary
District Trainer
Committee Chair
Event Coordinator or Designate
Rotoract Representative
Other
Preferred Method of Payment
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Check
ACH (you will be contacted to establish or confirm secured bank account information)
Reimbursement Payable To:
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Address
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City
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State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
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Phone number
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Email
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Expense Details
Total Amount Reimbursement Requested. MUST EQUAL TOTAL OF ATTACHED RECEIPTS
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Date or Date Range of Expense(s) Incurred
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List of Expenses Incurred With Dollar Amounts
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Documentation Required
Please upload all receipts, invoices or other documentation to support your expense reimbursement request below. It is recommended and requested that you consolidate your documents into one file for upload as it will speed up your reimbursement turnaround. However, there are additional upload fields below for your use. Should have more than 5 files to upload, you will need to create an additional expense reimbursement which may delay the timing of your reimbursement
Upload Receipts/Documentation for Reimbursement (Please consolidate)
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Additional Documentation/Receipt Files for Upload (IF NEEDED)
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Additional Documentation/Receipt Files for Upload (IF NEEDED)
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Additional Documentation/Receipt Files for Upload (IF NEEDED)
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Additional Documentation/Receipt Files for Upload (IF NEEDED)
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Additional Documentation (IF NEEDED)
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Signature
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Date:
Thursday, 26 December 2024 (EST)
Name:
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indicates required fields