City of Nashua, New Hampshire
2019 MILEAGE REIMBURSEMENT FORM
(For Mileage Incurred January 1, 2019 through December 31, 2019
Michae
Assessing
Name of Employee Department Name
Please Check
Hold Check for Pickup xX
Purpose of Travel Mail Check
Account to Charge:
32.1.600 Mileage
Accounting Unit Activity
§5307 Travel, Local - Mileage Basis
Account Account Category
Date travel was performed FE i _ - MILES TRAVELED. a
on a weekly basis
(Example. July 8 thru 15) SUN MON TUES WEDS THURS FRI SAT TOTAL
Assessing Property within City -
2/4/19 to 2/8/19 0 22 15 10 16 11 0 7400
Assessing Property within City -
2/11/19 to 2/15/19 i) 23 § 0 10 12 0 50 00
Assessing Property within City -
218/19 to 2/22/19 0 0 0 9 15 0 0 15.00
Assessing Property within City -
2/25/19 to 3/1/19 0 0 0 17 20 18 G 55 00
Assessing Property within City .
0 -
NOTES:
Total miles traveled 194.00
a} This form must be submitted to the accounts payable
department for reimbursement through Accounts Payable Rate per mile 0.580
b) The reimbursement rate is .58 cents per mile Total Mileage $ 112.52
(unless otherwise contractually agreed upon),
Tolls 0.000
Total $ $ 112.52
shyfia Wie
Date Submitted Empiéyee Signature
3ish9 Zz
Daté ayproved Appfoved b
EFFECTIVE DATE 01/01/2019
\CityFile\Users$\MandileM\My Documents\Mileage 2019\2-19
