Expense Account Statement 1
EXPENSE ACCOUNT STATEMENT

Employee: _
For period ending: _

REIMBURSABLE EXPENSES INCURRED

Hotel/Lodging                                       $_
Meals                                               $_
Tax                                                 $_
Travel [air, train, bus]                            $_
Personal auto _ miles x _ cents                     $_
Parking                                             $_
Phone                                               $_
Other [itemize]:
_                                   $_

Total:                                              $_
-------------------------

I certify the above is a true statement of incurred
expenses in accordance with company policy.  Receipts are
attached.


_______________________________
Employee


Approved for payment:


By:_____________________________

