West Contra Costa Unified School District

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West Contra Costa Unified School District

Mileage Reimbursement Claim Form #EC2

MILEAGE FORMS MUST BE TURNED IN MONTHLY

Name Mailing Address

School or Department City

Date

Zip

Phone

CLEAR

Date

Purpose of Trip

Starting Location

Destination

(Include address when outside of District)

Total Miles Park & Toll

Public Trans.

Out of District Travel Requires an Agenda or some type of notification about the meeting. I Hearby certify that the above is a true and accurate report of the travel expense incurred by me on approved school district business.

Total Miles

0.00

Do Not Write In

Mileage Rate Per Mile Subtotals Total Reimbursement

Account Code:

$ 0.545 $ 0.00

$ 0.00

This Space

0.00

0.00

Employee Signature

Date

Supervisor Signature

Date

Administrator of Funds Signature

Date

BP and Admin. Regulation 3350 and Education Code 44016,44032, and 44033 12/29/2016 mk

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