South Dakota ACDA Travel & Expense Voucher

 
  
 
   Name      State Committee Chair
 
   Home Street Address    
 
  
 
   City      Zip
 
  
 
   Home Phone      Work Phone
     
MILEAGE EXPENSES    
 
  
 
   From      To
 
  
 
   Purpose      Date

(Mileage)  _________roundtrip miles x $.51

=
$ ________________
     
MISCELLANEOUS EXPENSES (telephone, postage, supplies, etc.)
Item 1
 
$
Item 2
 
$
Item 3
 
$
Item 4
 
$

TOTAL EXPENSES DUE FROM SOUTH DAKOTA ACDA
$
 
  
 
   Signature      Date

Please attach all receipts and send to:

   
Date
 
   Check#
 
   Amount
$
 
Other: