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S TA TE O F C OLO RA DOG EN ER AL A SS EM BL Y
22SESSION TRAVEL EXPENSE - NON-METROFebruary 2011
SENATOR BACON
Total
.Roundtrip Mileage: Home to Capitol and Return130 miles @ $ 0.46 $ 59.80 2 WD Rate
Payment Requested:./
Mileago:+/TriPS @Per Diem: ~ s < Days @
$ 59.80
$ 150.00
Total Requested:
Please use this area for any comments or changes.
l$ertify that the statements in the above schedule are true and just in all respects; that payment of theamounts claimed herein has not and will not be reimbursed to me from any other sources; that my schedule oftravel was performed by me on official State business and not for personal purposes; and that I actuallyincurred or paid the operating expenses of the motor vehicle for which reimbursement is claimed on a mileagebasis.
Payee:Date:
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' .
STATE OF COLORADOGENERAL ASSEMBLY
23SESSION TRAVEL EXPENSE - NON-METRO
February 2011
SENATOR BROPHYRoundtrip Mileage: Home to Capitol and Return
342 miles @ $ 0.46 $ 157.32 2 WD Rate
Payment Requested:Total1 / 1 /__]_ Trips @
r . t1./ays @Mileage: $ 157.32$ 150.00 $ 4.D;;.D,tc>er Diem:Total Requested:
Please use this area for any comments or changes.
I certify that the statements in the above schedule are true and just in all respects; that payment of theamounts claimed herein has not and will not be reimbursed to me from any other sources; that my schedule oftravel was performed by me on official State business and not for personal purposes; and that I actuallyIncurred or paid the operating expenses of the motor 7h;J~~,WhtCh reimbursement is claimed on a mileagebasis. /lPayee: /
Date: ;1-( f>!(
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STATE OF COLORADOGENERAL ASSEMBLY
24SESSION TRAVEL EXPENSE - NON-METROFebruary 2011
SE NA TO R C AD MA NRoundtrip Mileage: Home to Capitol and Return
138 miles @ $ 0.46 $ 63.48 2 WD Rate
.Payment Requested:
_ j _ _ ! T r i P S @~Q,/~ Days @
Total
Mileage: $ 63.48
$ 150.00er D iem :
Total Requested:
Please use this a re a fo r any comments or changes.
I Certify that the statements in the above schedule are true and just in all respects; that payment of theamounts claimed herein has not and will not be reimbursed to me from any other sources; that my schedule oftravel was performed by me on official State business and not for personal purposes; and that I actuaJlyincurred or paid the operating expenses of the motor vehicle for which reimbursement is claimed on a mileagebasiS.
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STATE OF COLORADOGENERAL ASSEMBLY
SESSION TRAVEL EXPENSE - NON-METROFebruary 2011SENATOR GIRON
25
..~
Roundtrip Mileage: Home to Capitol and Return228 miles @ $ 0.46 $ 104.88 2 WD Rate
Payment Requested:
Mileage: Trips @ $ 104.88Total
I~ \~S"t:;$ S= t r&~y~oc:;,$v200 l-c5~;7 5 .2
$ ',l4\9 ..s~
Per Diem:
:Total Requested:
Days @ $ 150.00
., . . ~. _ p~se ~ this area for any comments or Changer' n "- - X ~A l/NlAft~~d ()jOLLA- (h')~. SJhv;X:V ~ J'l'1~cI ~~ D z r ' .
I certify that the statements in the above schedule are true and just in aU respects; that payment of theamounts claimed herein has not and will not be reimbursed to me from any other sources; that my schedule oftravel was perfonned by me on official State business and not for personal purposes; and that IactuallyIncurred or paid the operating expenses of the or vehicle for which reimbursement is claimed on a mileagebasis.
Payee:Date:
8/2/2019 Feb Sen 2011 Non-Metro
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S TA TE O F C OLO RA DOG EN ER AL A SS EM BL Y
SESSION TRAVEL EXPENSE NONMETROFebruary 2011SENATOR GRANTHAM
26
.- .
:Roundtrip Mileage: Home to Capitol and Return232 miles @ $ 0.46 $ 106.72 2 w e Rate
;Payment Requested:
Mileage: ~riPS @ $ 106.72
p.rDlom:~ Days @ $ 150.00
:Total Requested:
Total
u : 2 h e f C ./$$ ~Il.oo,l
Please use this area for any comments or changes.
I certify that the statements in the above schedule are true and just in all respects; that payment of theamounts claimed herein has not and w i J J not be reimbursed to me from any other sources; that my schedule oftravel was perfonned by me on official State business and not for personal purposes; and that I actuallyinc;urred or paid the operating expenses of the motor vehicle for which r' bursement is claimed on a mileagebasis. ~
Payee:Date:
8/2/2019 Feb Sen 2011 Non-Metro
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STATE OF COLORADOGENERAL ASSEMBLY
SES SIO N TRA VE L E XP EN SE - N ON -M ETR OFebruary 2011SENATOR KEITH KING
Roundtrip Mileage: Home to Capitol and Return150 miles @ $ 0.46 $ 69.00 2 WD Rate
Payment Requested:Total
Mileage: A:_ Trips @ $ 69.00 $ "'2.1~,t::C.:'PerOiem: 2 V Days @ $ 150.00 $ . : 1 : I:2CC) ~C::O
Total Requested:
Please use this area for any comments or changes.
I certify that the statements in the above schedule are true and just in all respects; that payment of theamounts claimed herein has not and will not be reimbursed to me from any other sources; that my schedule oftravel was performed by me on official State business and not for personal purposes; and that Iactuallyincurred or paid the operating expenses of the motor vehicle for which reimbursement is claimed on a mileagebasis.
Payee:Date:
27
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STATE OF COLORADOGENERAL ASSEMBLY
SESSION TRAVEL EXPENSE - NON-METROdanu8fY2.941'FEXbf,4 .p_ ' f c;l.0/SENATOR STEVE KING
28
Roundtrip Mileage: Home to Capitol and Return508 miles @ $ 0.46 $ 233.68 2WD Rate
Payment Requested:Mileage: # Trips From To S1Way . . . 1 @ $ 116.84 Grand Jct DenverRound Trip II v 1 @ $ 233.68 Grand Jet Denver q~. ,.:l,.
I Mileage ~ " 1 L l. 1:L.otal SAirfare: Dates To $1Way - Grand Jet DenverRound Trip - Denver Grand JetRoundTrip - Denver Grand JctRound Trip - Denver Grand JetRound Trip - Denver Grand Jet1Way - Denver Grand JctAirfareTotal $Misc. Expenses:Per Diem: 8 V ' @ $ 150.00 $ '1.2CO.eQDays .Total Requested: $ 5. 1"~!];2..
Please use this area for any comments or changes.
Icertify that the statements in the above schedule are true and just in aUrespects; that payment of the amountsclaImed herein has not and will not be reimbursed to me from any other sources; that my schedule of travelwasperformed by me on official State business and not for. ersonal purposes; and that I ctually incurred or paidthe operating expenses of the motor vehicle for whic imbursem ai on a Ileagebasis.
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STATE OF COLORADOGENERAL ASSEMBLY
29SESSION TRAVEL EXPENSE NONMETRO
February 2011SENATOR LAMBERT
Total
:Roundtrip Mileage: Home to Capitol and Return130 miles @ $ 0.46 $ 59.80 2 WD Rate
Payment Requested:
Mileage:,/"
'i Trips @ $ 59.80Per Diem: ~ B . . /~ Days @ $ 150.00 $ t . / J _ 00. DO./
:Total Requested: $t(t{2 C f .2 01/
Please use this area for any comments or changes.
I certify that the statements in the above schedule are true and just in all respects; that payment of theamounts claimed herein has not and will not be reimbursed to me from any other sources; that my schedule oftravel was performed by me on official State business and not for personal purposes; and that Iactuallyineurred or paid the operating expenses of the motor vehicle for which reimbursement is claimed on a mileagebasis.
Payee:Date: F . . J IS :lOll
8/2/2019 Feb Sen 2011 Non-Metro
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STATE OF COLORADOGENERAL ASSEMBLY
30SESSION TRAVEL EXPENSE - NON-METRO
February 2011
SENATOR LUNDBERG
Total
:Roundtrip Mileage: Home to Capitol and Return100.2 miles @ $ 0.46 $ 46.09 2we Rate
,Payment Requested:L . / -Mileage: -+--- Trips @ $ 46.09
Per Diem: Q.5ays @ $ 150.00 $ 3,150.c::;:C)Total Requested:
,. .Please use this area for any comments or changes.
I ce rtify that the statem ents in the above schedule are true and just in all respects; that paym ent of theamounts claim ed he re in has not and w ill not be re im burse d to m e from any othe r source s; that m y sche dule of~ I w as perform ed by m e on officia l S tate business and not for personal purposes; and that I actuallyincurre d or paid the ope rating e xpe nse s of the m otor ve hicle for w hich re im burse me nt is cla im ed on a m ile agebasis.
Payee:Date:
8/2/2019 Feb Sen 2011 Non-Metro
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S TA TE O F C OLO RAD OG EN ER AL A SS EM BL Y
31SESSION TRAVEL EXPENSE - NON-METROFebruary 2011
SENATOR MORSE
. Total Requested:
Roundbip Mileage: Home to Capitol and Return154 miles @ $ 0.46 $ 70.84 2 WD Rate
. Payment Requested:Total../
Mileage: 1/ Trips @ $ 70.84 $ : 2 .1 > " S o . . ~
./ $ Lf~~.c:oer Diem: Z:l? Days @ $ 150.00
Please use this area for any comments or changes.
I.certify that the statements in the above schedule are true and just in all respects; that payment of theamounts claimed herein has not and will not be reimbursed to me from any other sources; that my schedule oftravel was performed by me on official State business and not for personal purposes; and that IactuallyIncurred or paid the operating expenses of the motor vehicle for which reimbursement is claimed on a mileagebasis.
Payee: ~Date: 0z --s - : / /
8/2/2019 Feb Sen 2011 Non-Metro
11/21
S TA TE O F C OLO RA DOG EN ER AL A SS EM BL Y
SESSION TRAVEL EXPENSE - NON-METROFebruary 2011SE NA TO R R EN FR OE
Roundtrip Mileage: Home to Capitol and Return132 miles @ $ 0.46 $ 60.72 2 WD Rate
Payment Requested:Total'- \ ./
$ 60.72 $ ~l\~. t5~ \I "ileage: Trips @~~v $ Y~OO /Per Diem: Days @ $ 150.00Total Requested:
Please use this area for any comments or changes.
":
I certify that the statements in the above schedule are true and just in atl respects; that payment of theamounts claimed herein has not and wil l not be reimbursed to me from any other sources; that my schedule oftravel was performed by me on official State business and not for personal purposes; and that I actuallyincurred or paid the operating expenses of the motor vehicle for which reimbursement is claimed on a mileagebasis.
Payee:Date:
32
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STATE OF COLORADOGENERAL ASSEMBLY
SESSION TRAVEL EXPENSE - NON-METROFebruary 2011SENATOR ROBERTS
:Roundtrip Mileage: Home to Capitol and Return680 miles @ $ 0.46 $ 312.80 2WD Rate
.Payment Requested:
Airfare:Trips , $ 312.80
t?c.~W (~~~t'~~)Total
$$ ~3(...2.0 ../$ !C. . O"'b v$ 4. :200 (Tl) ./
Mileage:
Parking:'?'I./ Days @er Diem: $ 150.00
" 'i Total Requested:
Please use this area for any comments or changes.
I ce rtify that the statem ents in the above sche dule are true and just in aU respects; that paym ent of theam ounts claim ed here in has not and w ill not be re im bursed to m e from any othe r source s; that m y schedule oftrave l w as perform ed by m e on officia l S tate business and not for pe rsonal purpose s; and that Iactual lyin curre d or paid the ope rating e xpe nse s of th e m otor ve hicle for w hich re im bu rse me nt is claim ed on a m ile agebasis.
payee:~_~Date: ~ ":7/", I
33
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United Airlines
Ellen RobertsFrom: [email protected]: Saturday, January 22, 2011 9:09 AMTo:
A'"Subject: Your United flight confirmation - February4, 2011 - Denver to DurangoI l6UNITED
1 1 1 / UnitedConfirmation # M1
Flight infoFri, Feb 04, 2011FlightlIII U n ite d 6 5 89O pe ra te d b y:UnitedExpressJskywestAirl ines
> Printreservation> Viewitinerary> EasyCheck-in Online
Seats10 0
E qu ip me nt: C RJ I O u ra tio n: 1 h 3 m I N on -stop I F are code : Q E7 3C NTrave le d m ile s:2 51 I A ward m ile s:2 38I N o M eal S ervice
Sun, Feb 06, 2011Durango, CO (ORO) Denver, CO (DEN)FlightI I J I U nit ed 6 5 42O pe ra te d b y:UnitedExpress/skywestAirl ines
Check-in information
DepartO R O 1 1: 48 AM S u n , Fe b 6, 2 011
ArriveDEN 12 :5 0 PMS u n : Fe b 6, 2 011
CabinE co no my (0 )
Seats11 C
E qu ip me nt: C RJ j D ur atio n: 1h 2 m I Non-stop j F are c od e: O E7 3C NTrave le d m ile s:2 51 I A ward m ile s:2 38! N o M eal Se rvice
P le as e n ote th at v alid , g ov ern me nt-is su ed p ho to id en tific atio n m us t b e p re se nte d a t c he ck -in .B ecause you are a value d M ile age Plus Pre mie r m em be r, w e have re que ste d an U nlim ite d D om esticU pgrade on your be half. P le ase che ck M y R ese rvations 48 hours be fore your sche du le d de parture to le arn ify ou r u pg ra de h as b ee n c on firm e d.
ReviewName Frequent flyer Additional Fare subtotaltaxes and fees (5)icket Fare(s)E LL EN R OB ER TS 0 31085 12 678 0162 1192 70916 2 1.40 U SD 305 .40 U SD84.00USD" Secure Flight data com ple te Review
P le as e re vie w th e fa re ru le s fo r th is itin era ry .
2/17/2011
F are total: 305 .4 0 U SD
Page 1 of 4
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United Airlines
Purchase summaryProduct Credit card:
Visa~icket price
Itinerary total:
Billing I Delivery informationELLEN S S R OBER TSPOBOX 1923 DURANGO CO 81302-1923 USA
Book your hotelLocation Dates of stay Hotel RatingPurgatory - 02/04-02/06 Durango Super 8 'l~lDurango MotelPurgatory - 02/04-02/06 Hampton Inn ' } . fU'C.Durango DurangoPurgatory - 02/04-02/06 Doubletree Hotel in:.n:n::Durango Durango
More hotels
Reserve your car with the United discount
Page ~ of4 .
Receiptr J M ! 6 M A PriceI G ~III Ticket total: 305.40 USD
Grand total: 305.40 USD
PriceAs low as USD49.00 per night
" B O O k n o . , . , . . ]As low as USD63.20 per night[ ' B O O k n o w . , , ]
As low as USD100.80 per nighttW a O O k n Q W ]
LlAIf,'"". . . .~ Save up to 25% with the United discount and earn triplemilesPlus, earn a 1,000 mile online booking bonus ReservenowEnhance your travel experience
United Mileage Plus VisaEarn 30,000 miles, and 1 mile per eligible $1. Redeem with noblackouts. Apply now.__/I"__.-.-- _Protect your travel plans with Trip Protector offered by UnitedC,7lt'tessAmerkawith Access America. Learn more.
211712011
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United Airlines
E llen Roberts
Page 1 of 4
From: [email protected]: Saturday, January 22,2011 9:14AMTo:. g &Subject: Your United flight confirmation - February 18, 2011 - ~:ver to DurangoMUMITED
N I l UnitedConfirmation # M16BP4 > Printreservation> Viewitinerary> EasyCheck-in Online
Flight infoFri, Feb 18, 2011Denver, CO (DEN) Durango, CO (ORO)Flight Depart ArriveIll! United 6294 DEN 04:09 PM ORO 05:12 PMOperated by: 'FrCFeb 18, 2011 Fii:Feb 18, 2011UnitedExpress/skywestAirlines
CabinEconomy (V)
Seats090
Equipment: CRJ I Duration:1h 3m I Non-stop I Fare code: VE143CNTraveled miles:251 I Award miles:238 J No Meal ServiceSun, Feb 20, 2011Durango, CO (ORO) Denver, CO (DEN)Flighttill United 6542Operated by:UnitedExpress/skywestAirlines
DepartDRO 11:41 AMs i : i r i ; Feb 20, 2011
ArriveDEN 12:42 PMS u n : Feb 20, 2011
CabinEconomy (V)
Seats10D
Equipment: CRJ I Duration:1h 1m I Non-stop I Fare code: VE143CNTraveled miles:251 I Award miles:238I No Meal ServiceCheck-in infonnationPlease note that valid, government-issued photo identification must be presented at check-in.Because you are a valued Mileage Plus Premiei member, we have requested an Unlimited DomesticUpgrade on your behalf. Please check My Reservations 48 hours before your scheduled departure to learn ifyour upgrade has been confirmed.
ReviewNam e Additional Fare subtotaltaxes and fees (5)requent flyer Ticket Fare(5)ELLEN ROBERTS 03108512678 21.40 USD 265.40 USD162119264488 244.00USDo Secure Flight data complete ReviewPlease review the fare rules for this itinerary. Fare lolal: 265.40 USD
2117 /2011
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United Airlines Page 2.of 4 .
Purchase summaryProductT ic ke t p ri ce
Credit card:Visa xxxxxxxxxx ,. .
ReceiptM 1 6 B F P & Price9 1 . 1 8 b t u T icke t to tal: 2 65 .4 0 U SD
Itinerary total: Grand total: 265.40 USD
Billing I Del ivery informationELLEN S S ROBER TSPO BOX 192 3 DUR ANG O CO 81302 -192 3 USA
Book your hotelLocation Dates of stayP urg ato ry - 02/18-02 /20DurangoP urg ato ry - 02/18-02 /20DurangoP urg ato ry - 02118 -02120Durango
M o re h ote ls
Hotel Rating PriceAs low as USD 71.2 0 per nightlSoDknow .): " :ampton InnDurango
Doubletree HotelDurango
As low as USD 99.00 per night[ B o Q k o o w ]As low as USD100.80 per nightL ' " B O O k o o w " l
Historic StraterHotel
Reserve your car with the United discountSave up to 25% with the United discount and earn triplemilesPlus, earn a 1,000 mile online booking bonus Reservenow
Enhance your travel experienceUnited Mileage Plus VisaEarn 30,000 miles, and 1 mile per eligible $1. Redeem with noblackouts. Apply now.
_If'__.'~' .P~otect your travel. plans with Trip Protector offered by United~essAmerrca with Access America. Learn more.
2 /1712011
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Un it ed A ir lin e s
Ellen RobertsFrom: [email protected]: Saturday, January 22, 2011 9:33 AMT o : . . ,Subject: Your United flight confirmation - February 25, 2011 - Denver to DurangoI8IUNITED
1 /1 UnitedConfirmation # M37S51 > Printreservation> Viewitinerary> EasyCheck-in Online
Flight infoFri, Feb 25, 2011Denver, CO (DEN) Durango, CO (ORO)Flightfill United 6294Operated by:UnitedExpress/skywestAirlines
DepartDEN 04:09 PMFi{Feb 25, 2011
ArriveORO 05:12 PMFrCFeb25,2011
CabinEconomy (V )
Seats090
Equipment: CRJ I Duration:1h 3m I Non-stop I Fare code: VE143CNTraveled miles:251 I Award miles:238I No Meal Service
Sun, Feb 27, 2011Durango, CO (ORO) Denver, CO (DEN)Flightl 1 l i United 6542Operated by:UnitedExpress/skywestAirlines
DepartORO 11:41 AM S u f i " ; Feb 27, 2011
ArriveDEN 12:42 PM S u n , Feb 27,2011
CabinEconomy (V )
Seats090
Equipment: CRJ IDuration:1h 1m I Non-stop IFare code: VE143CNTraveled miles:251 I Award miles:238I No Meal ServiceCheck~ninforrnationPlease note that valid, government-issued photo identification must be presented at check-in.Because you are a valued Mileage Plus Premier member, we have requested an Unlimited DomesticUpgrade on your behalf. Please check M y Reservations 48 hours before your scheduled departure to learn ifyour upgrade has been confinrned.
ReviewName Additional Fare subtotaltaxes and fees (s)requent flyer Ticket Fare(s)ELLEN ROBERTS 03108512678 244.00USD 21.40 USD 265.40 USD162119272325f) Secure Flight data complete ReviewPlease review the fare rules for this itinerary. Fare total: 265.40 USD
2117/2011
Page I of 4
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United Airlines Page 2 . of 4
Purchase summaryProductTicket price
Credit card:Visa JO()()(Xxx~
ReceiptM _ - m - n . t z c " " " " . , . . . . . .PriceTicket total: 265.40 USD
Itinerary total: Grand total: 265.40 USD
Billing I Delivery informationELLEN SSROBERTSPO BOX 1923 DURANGO CO 81302-1923 USA
Book your hotelLocation Dates of stayPurgatory - 02/25-02 /27DurangoPurgatory - 02125 -02127DurangoPurgatory - 02/25-02127Durango
More hotels
Hotel Rating PriceAs low as USD63.20 per night
[aOokft9Vt . . lHampton InnDurangoDoubletree HotelDurango
As low as USD93.80 per nightI . , 8 0 0 1 ( ~wJ
As low as USD99.00 per nightr a O j ~ n o w ]istoric StraterHotelReserve your car with the United discount
Save up to 25% with the United discount and earn triplemilesPlus, earn a 1,000 mile online booking bonus Reservenow
Enhance your travel experienceUnited Mileage Plus@VisaEarn 30,000 miles, and 1 mile per eligible $1. Redeem with noblackouts. Apply now.
_ A ' __ . . . _ , Protect your travel plans with Trip Protector offered by United~essAmertCc\with Access America. Learn more,
2 / 1712011
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DENVER INTFRNATIONAIAIRPORT
8 5 0 0 P e n a B 1 v e l .[ ] e n v e r , C O 8 0 2 4 9
C a r ' d A c c o u n t : . X . ' X X f J X f , q,C a r n T Y lJ e : V l s aAutIIOIl/,d]On C o e le : 4 f;/'iIUC a s t l le r ' : ] ' S e C ! # 0 % 5I irense P J ate : N O ftA i r .E n t : 1 7 : 0 1 0 2 / 0 4 / 1 1 l a n ~ 1 2['xU: 13' 23 0('/06/11 tane 10Dur.]' ](Ji': ID (s) 2 0H (s) l!jI1(';)R , e ; , ' ) ' : ; : '1 0
fit ~ : 1 G . 0 0~Wl lm! f U ~ L 1 $ 3 G . O OC A : ; i I $ 0.00
r _ I-I' C A l ; : ) $ 3 6 . 0 0'-;. :I( i lhCK $ D . U O.llliNer C A L C $ 0 . 0 0
I J A 1 0 A I c r . J L . C OT i l X t ; : , r ! " I ( - l l j { U ; l - I
* . l * !i " , ' : 1 1 .* *
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STATE OF COLORADOGENERAL ASSEMBLY
SESSION TRAVEL EXPENSE - NON-METROFebruary 2011SEN ATO R SC H WAR TZ
. Roundtrip Mileage: Home to Capitol and Return394 miles @ $ 0.46 $181.24 SNMV472 miles @ $ 0.46 $ 217.12 ALAMOSA402 miles @ $ 0.46 $ 184.92 GUNNISON
Payment Requested:
S N MV Mileage:,ALAMOSA Mileage:GUNNISON Mileage:
Total
l ./ Trips @ $ 181.24 $ If} L - z . . . + . /I ./ Trips @ $ 217.12 $ a -J , . 1;1. V'Trips @ $ 184.92
$Ob .; Days @ $ 150.00 $ 3900 ../
Airfare:Per Diem:
total Requested:
Please use this area for any comments or changes.
I certify that the statements in the above schedule are true and just in all respects; that payment of theamounts claimed herein has not and will not be reimbursed to me from any other sources; that my schedule oft~vel was performed by me on official State business and not for personal purposes; and that I actuanyincurred or paid the operating expenses of the motor vehicle for which reimbursement is claimed on a mileagebasis.
payee:
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STATE OF COLORADOGENERAL ASSEMBLY
35SE SSIO N TR AV EL EXP EN SE - NO NM ETR O
February 2011SENA TO R W H ITE
Roundtrip Mileage: Home to Capitol and Return360 miles @ $ 0.46 $ 165.60 2 w e Rate
;Payment Requested: ? : " " Trips @ $ 165.60 Total$ 49L,tgoileage:Airfare: From To $ates
1Way -Round Trip -Round Trip -Round Trip -Round Trip -1Way -
Airfare TotalS
'Misc. Expenses:R/. : t Days @ $ 150.00 $ ' i f .2 .c:O. ex;>
$ 'i.~ ' ( p 1>0:Per Diem:Total Requested:
Please use this area for any comments or changes.
I oertify that the statements in the above schedule are true and just in all respects; that payment of theamounts claimed herein has not and will not be reimbursed to me from any other sources; that my schedule oftravel was performed by me on official State business and not for personal purposes; and that I actually~::~ or paid the operating expenseffs of the motor vehicle for which reimbursement is claimed on a mileage
Payee: ~r~ ~Date: ~r5 /I(