STATE OF MISSOURI                                                                                            FOR MONTH/YEAR OF:
                      MONTHLY EXPENSE REPORT
                                                                                                                                   DEPARTMENT/DIVISION
         THE WHITE AREAS MUST BE COMPLETED.  THE GRAY AREAS ARE OPTIONAL FOR AGENCY USE.
         EMPLOYEE NAME (LAST, FIRST)                                                                                               VENDOR CODE (SOCIAL SECURITY NUMBER)
         OFFICE ADDRESS
           DATE                   PURPOSE, FROM/TO, & TRAVEL TIMES                OVER-NIGHT  12-HOUR STATUS  STANDARD     FLEET   BREAK-FAST   LUNCH      DINNER      LODGING     BUS/R.R./  AIR
                                                                                    STAY (X)        (X)         MILES      MILES
                                                                                         TOTALS OF ABOVE »                              0.00       0.00       0.00         0.00         0.00 
                                                                                TOTALS FROM OTHER PAGES »
                                                                                    TOTAL STANDARD MILES »             0                              AT 0.370      PER MILE
                                                                                        TOTAL FLEET MILES »            0         0                    AT   0.260    PER MILE
                                                                                                                                                     TOTAL REIMBURSABLE EXPENSE »
         DATE          * EXPLANATION OF MISC. & AMOUNT                        DATE            *EXPLANATION OF MISC. & AMOUNT                                        DATE         *EXPLANATION OF MISC. & AMOUNT
         I hereby certify the above claim is correct, that these expenses were necessary to conduct business, that payment has been made
         from personal funds for which I have not been reimbursed, nor will I receive from any source any payment for these expenses.
         APPROVAL SIGNATURE                                                                                              CLAIMANT SIGNATURE
         TITLE                                                                DATE APPROVED                              TITLE
         Meals:  Cannot exceed state M&IE per destination.  Refer to http://oa.mo.gov/accounting/state-employees/travel-portal-information/state-meals-diem for meal rates.
         Mileage:  Cannot exceed state mileage rate for the vehicle driven.  Refer to http://oa.mo.gov/accounting/state-employees/travel-portal-information/mileage for rates.
    Lodging:  Refer to http://www.gsa.gov/portal/category/21287 for rates.  Provide justification where daily room rate (prior to taxes) exceeds the federal GSA rate.
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                      DEPARTMENT/DIVISION
                      VENDOR CODE (SOCIAL SECURITY NUMBER)
                                                                         MISC.*     TOTAL
                                                                                 $               0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
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                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                                          0.00 
                                                                           0.00   $               0.00 
                                                                                 $               0.00 
                                                                              »  $               0.00 
                                                                              »  $               0.00 
                                                                              $          0.00 
                                                           *EXPLANATION OF MISC. & AMOUNT
             CLAIMANT SIGNATURE                                                 DATE
                                                                      OFFICIAL DOMICILE
                                           Revised 8-26-14