City of Nashua, New Hampshire
2019 MILEAGE REIMBURSEMENT FORM
{For Mileage Incurred January 1, 2019 through Decembe; 31, 2019
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Approved by
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
55307 Travel, Local - Mileage Basis
Account Account Category
|Date travel was performed . MILES TRAVELER -
on a weekly basis
(Example: July 8 thru 15) SUN MON TUES WEDS THURS FRI SAT TOTAL
Assessing Property within City -
3-4-19 to 3-8-19 0 0 0 7 6 16 0 29.00
Assessing Property within City -
3-11-19 to 3-15-19 0 4 0 7 6 7 0 18 00
Assessing Property within City -
3-18-19 to 3-22-29 0 § 0 0 0 5 0 10.00
Assessing Property within City -
3-25-19 to 3-29-19 0 0 3 0 0 3 0 6.00
NOTES:
Total miles traveled 63.00
a) This form must be submitted to the accounts payabie
department for reimbursement through Accounts Payable Rate per mile 0.580
) The reimbursement rate is .58 cents per mile Total Mileage $ 36.54
(unless otherwise contractually agreed upon).
Tolls 0.000
Total $ $ 36.54
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Employ
EFFECTIVE DATE 01/01/2019
\CityFile\Users$\MandileM\My Documents\Mileage 2019\3-19
