AFSCME LOCAL 1703 EXPENSE REPORT

Name: ______________________________ Signature: _________________________

Address: ____________________________

____________________________ Approval: _________________________

City State Zip Code

____________________________

Area Code Telephone No.

Date	Place and Purpose	Mileage		Per Diem	Lodging (Attach Receipt)	Other Explain & Attach Receipts	Amount
		Miles	Cost
TOTALS

For Treasurer’s Use Only

Date Paid ________

Check Number ________

Treasurer’s Initials ________

Explanation/Comments: Total Expense: