TRAVEL,MEALAND LODGINGEXPENSEREIMBURSEMENTREQUEST FORM
Before an expense for travel, meals, or lodging may be approved under City of
Momence, Illinois, Ordinance No. 823, the following minimum documentation must first be
submitted, inwriting, to the corporateauthoritiesof theCity ofMomence, Illinois:
(1)
The name of the individual who received or is requesting the travel, meal, or
lodgingexpenseand the individual’s job titleor office.
___________________________________
Nameof EmployeeorOfficer
___________________________________
JobTitle/Office
(2)
Thedateor dates andnatureof theofficial business inwhich the travel,meal, or
lodging expense was or will be expended. Please attach supporting
documentationdescribing thenatureof theofficial business event or program.
_________________________
________________________
Nameof Event or Program
Date(s) of Event or Program
_________________________
________________________
Locationof Event or Program
Purposeof Event or Program
(3)
An estimate of the cost of travel, meals, or lodging if expenses have not been
incurred or a receipt of the cost of the travel, meals, or lodging if the expenses
have already been incurred. Please attach either (a) a document explaining the
basis for your estimate if expenses have not yet been incurred or (b) receipts if
theexpenseshavealreadybeen incurred.
You may also provide such other documentation as would assist the corporate
authorities in considering your request for reimbursement. In the discretion of
the corporate authorities, additional documentation relevant to the request for
reimbursementmaybe requiredprior toactionby the corporateauthoritieswith
respect to the reimbursement request.
___________________________________
_______________________
Employee/Officer Signature
Date
