UAV EXPENSE REIMBURSEMENT FORM

EXPENSE REIMBURSEMENT
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Email *
example@example.com
Date Submitted for Reimbursement
Address *

Street Address

Street Address Line 2

City State

Zip Code
Date of Expense *
Authorization For Expense *

UAV Chair Board of Directors Operating Instructions
What is the reason for this expense? *

Purchase General Administrative Supplies (see next question) Purchase Supplies or Equipment for UAV Programs (see next question) Participate in AVHOF Selection Process Instructor for Regional AVHOF Nominator Training
If known, what is the budget line item for this expense. *

General Account AZ Veterans Hall of Fame Event Account Scholarship Account (General) Scholarship, Native American Scholarship, Veteran Scholarship, Veteran Family
MILEAGE, if claimed. If mileage is claimed, fill in the following. Mileage will normally be calculated from city to city, not street to street. UAV will reimburse round trips of 100 miles or more at $0.25 per mile.
Indicate the city travelled to. Also, if "Other" was selected for Reason For Travel, please clarify.
If items were purchased or other expenses incurred, please list and attach copies of the receipts as required below.
If an OVERNIGHT STAY is claimed, click YES and submit a receipt as required below. UAV will reimburse you up to $100 per night.

YES NO
Attach Any Receipts or mail them to UAV Treasurer.

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Unified Arizona Veterans, ATTN: Treasurer, P. O. Box 34338, Phoenix, AZ 85067 Cancel of
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