Relocation Expense Reimbursement Form

Relocation Expense Reimbursement Form

Banner Document # I

Name: Olivia Beaver

OSU ID#: 999-123-456

Date Prepared: Sep 16, 2012

Address:

Department Contact: Sallie Sue

Corvallis, OR

Contact Phone: 7-1234

Brief description of move:

New employee came to house hunting June 22-26th, 2012 from Boston, MA to Corvallis, OR with family members. Olivia's spouse drove the personal car Aug. 1- 5, 2012 from Boston to Corvallis Olivia flew with children on Aug. 5th, 2012 to Portland, OR and took Hut Shuttle from PDX to Corvallis Needed to stay in temporary housing Aug 5th - 15th, 2012 awaiting personal items to arrive at new home.

House Hunting Transportation between new and old location (include dates and # of miles) Employee and Spouse - Round trip Airfare 6/22 - 6/26/12 from Boston to PDX to Boston ($375.80 x 2) Car Rental - 6/22-6/26/12 Gas for Rental

$751.60 $281.41 $43.71

Transportation in vicinity of new location (include dates and # of miles)

Meals and lodging (includes dates, meal per diem, and lodging per diem) Lodging at Comfort Suites, Corvallis, OR 6/22-6/25/12 - 4 nights @ $145.13/night includes tax Meals for new employee plus family members @ 104/day x 5 days

$580.52 $520.00

Moving Moving and storage of household goods (include dates, vendors, and amounts) Packing Supplies (Staples & Uhaul receipts) Moving Company - Mayflower paid by employee Storage - 1st 30 days

Total House Hunting Cost $2177.24

$92.89 $6566.87 $148.16

Lodging and Transportation (include dates, lodging per diem, and # of miles) Employee's spouse drove personal vehicle - mileage (Google Map) @ 3168 miles * 0.555/mile Lodging - Quality Inn/OH 8/1/12 @ $97.36/night, Holiday Inn/IA 8/2/12 @ $106.92 Lodging - Holiday Inn/NA 8/3/12 (capped at $111 plus tax 16.10), Hampton Inn/UT 8/4/12 @ $84.99 Lodging - Corvallis, OR 8/5/12 - At Home In OR - Condo 1st night Airfare for spouse and children (3 one way tickets Boston to PDX @ 388.84/ea) 8/5/12 and Baggage Fees - 2 @ 50 Hut Shuttle Service - 8/5/12 - 3 people (1 adult - 2 kids /free) / PDX to Corvallis Meals (include dates and meal per diems) Self - during drive from Boston to Corvallis 8/1/12 - 8/5/12 arrived at noon on last day (5 days @ $52) Family member per diem - 1 day 8/8/12 during air travel

$1758.24 $204.28 $212.09 $125.00 $1266.52 $48.00

$260.00 $52.00

Revised 08/21/2012

Total Moving Cost $10734.05

Temporary Living Meals and Lodging (include dates, meal per diem, and lodging per diem 9 days lodging @ At Home in OR/ self and family waiting for permanent residence to become available 10 days of meals for self and family members (10 * 104/day)

$1125.00 $1040.00

Miscellaneous Other miscellaneous expenses (include dates and description of expenses) Utility hook up - Powers R Us Closing costs

Total Temporary Living $2165.00

$180.00 $1320.00

Total Miscellaneous $1500.00 Total Relocation Expenses Claimed $16576.29

Taxable amounts paid through Payroll will be submitted by Business Affairs-FA&A to Central Payroll. Refer to the OSU Relocation and Moving FIS Policy - FIS 415 for information.

I certify that this claim is true and correct; that no part thereof has been heretofore claimed or will be claimed from any other source.

Claimant's Signature:

Date:

Budget Authority Approval I certify that the expenses(s) itemized above have been reviewed and are an accurate, allowable, and appropriate expenditures. It is within my budgetary authority to approve the above expense(s).

Printed Name:

Signature:

Date:

Index Code QWX123

Business Affairs - Financial Accounting & Analysis Use Only

Account Code

Activity Code

10790 non-taxable via A/P

Payment Amount $9392.45

10780 taxable via A/P

QWX123

10217 taxable via Payroll

$7183.84

Total Payment Amount $16576.29

Additional Notes:

Business Affairs has reviewed for moving allowance and approved to create invoice for $9392.45 on non-taxable account code 10790. The balance of the reimbursement for $7183.84 is taxable and will be submitted to payroll in September 2012 for reimbursement. Total claim is $16,576.29. Stephanie Smith/FA&A 7-1825

Revised 08/21/2012

E-mail itinerary

Page 1 of 3

E-mail itinerary From: "Orbitz"

To: oliviab@

Tuesday, June 12, 2012 9:17 PM

E-mail itinerary

Dear Olivia, This message has been sent from Trip name: Oregon June Visit

Traveler information

Name and contact information Hotel reservations under:

Olivia Beaver

Hotel Information

Orbitz record locator PBOORB115552174 To make changes to your trip, go to Trip Details

Hotel

Comfort Suites Corvallis hotel details|map Hotel confirmation number: 12345 1730 NW 9th Street, Corvallis, OR 97330 US Phone: +1 (541) 753-4320|Fax +1 (541) 754-0535

Date and time:

Check in: Fri, June 22, 2012 | Check out: Tue, June 26, 2012 Hotel check-in/check-out: 03:00 PM 12:00 PM

Reservation

Room(s): 1 | Guest(s) 4 | Night(s): 4

Olivia Beaver must check in to this room.

Guest(s) 4 | Night(s): 4

Room description: 2 Double, wireless internet, complimentary, dial-up internet, complimentary, 25in tv

Special requests: Non-Smoking *Special requests are sent to the hotel but cannot be guaranteed. Orbitz recommends that you contact the hotel directly to ensure your request can be accommodated.

Cost and Billing Summary

This booking is subject to our Privacy Policy and our Terms and Conditions

Your current trip cost

Hotel

Nights: 4

$516.00

Guests: 4 Rooms: 1

Taxes and Fees

$64.52

Total due at booking Price Assurance

$580.52

This reservation was made on Thu, May 17, 2012 8:07 PM CDT.

Billing information

Card holder's name: Olivia Beaver

Card type: MasterCard

Card number: ************1234

Billing Address: 166 Oakville Circle Boston, MA 02132 US

Hotel policies and additional billing information.

Cancellation:



eTicket Itinerary and Receipt for Confirmation DWWER5

Alaska Airlines To: oliviab@

Thu, May 10, 2012 at 6:36 PM

Confirmation: DWWER5

Issue Date: May 10, 2012

Check-In>

Traveler BEAVER/OLIVIA BEAVER/WALTER BEAVER/FRED BEAVER/LUCY

eTicket Number 05489876578511 05489876578512 05489876578513 05489876578514

Frequent Flyer

Seats 35D/15A 35B/15C 35C/15B 35E/15D

FLIGHT INFORMATION

Day, Date

Flight Class

Fri, 22JUN12 25

S

Fri, 22JUN12 2015 S

Tue, 26JUN12 2170 S

Tue, 26JUN12 24

S

Departure City and Time Boston (BOS) 8:00AM Seattle (SEA) 12:10PM Portland (PDX) 2:30PM Seattle (SEA) 4:20PM

Arrival City and Time Aircraft Seattle (SEA) 11:10AM 787 Portland (PDX) 12:57PM 787 Seattle (SEA) 3:20PM 787 Boston (BOS) 11:33PM 787

FARE INFORMATION Fare Breakdown Airfare: U.S. Flight Segment Tax: September 11th Security Fee: U.S. Federal Transportation Tax: Per Person Total: eTicket Total:

345.75 7.40 5.00

17.65 375.80 USD 1503.20 USD

Form of Payment: MasterCard Last Four Digits 1234

Fare Rules: Additional charges may apply for changes in addition to any fare rules listed. NONREF/0VALUAFTDPT/CHGFEE Cancel reservations before the scheduled departure time or TICKET HAS NO VALUE.

eTicket Reminders

? Check-in Requirement ? Bags must be checked and boarding passes obtained at least 30 minutes prior to scheduled departure. Baggage will not be accepted and advance seat assignments may be cancelled if this condition is not met.

? Boarding Requirement ? Passengers must be prepared to board at the departure gate with their boarding pass at least 15 minutes prior to scheduled departure.

? Failure to meet the Boarding Requirements may result in cancellation of reservations, denied boarding, removal of checked baggage from aircraft and loss of eligibility for denied boarding compensation.

Budget confirmation code: 0088002514US6 ? Your car rental is confirmed. Hotwire Itinerary: 369778925

Thank you for booking your travel with Hotwire. Please note that all bookings are final and no changes or refunds are allowed. We've saved this information in your account. You do not need to reconfirm with Budget or Hotwire.

For your trip:

Print this page or the confirmation email sent to

1 you at oliviab@ and take it with you

when traveling. This confirmation is your receipt of payment and should be presented when you pick up your car.

For directions, hours of operation, or for special

2 requests such as GPS, child seats, racks, and

additional drivers, please call your car rental agency at the phone number listed in the contact information. An additional fee may be required for special request items.

Congratulations, you saved 29% Mid-size car

Hotwire Hot Rate of just $40.95 Other travel sites: $57.81

Trip Details Mid-size car

Hotwire Hot Rate

Portland, PDX Portland, Oregon 7000 NE Airport Way

Pick-up details Fri, Jun 22, 2012 at 1:00PM

Drop-off details Tue, Jun 26, 2012 at 4:00PM

Miles Includes unlimited mileage Seating 4 adults

Cargo 1 large, 2 small suitcase Models Toyota Corolla, Dodge Avenger, or similar

Features Automatic, Power Steering, Air Conditioning, Air Bags, AM/FM

Driver name Olivia Beaver

Contact information

Car rental Budget 1-800-527-0700 Confirmation code: 0088002514US6

You do not need to reconfirm your booking with the car rental agency or Hotwire.

Hotwire Customer Care By phone - anytime U.S./Canada toll free 1-866-HOTWIRE



 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download