Business Meal Certification Form
Department Information
Agency:
Department Name:
Source of Funds (AIS Department Number):
Requested by:
Date:
Event Information
Scheduled Meeting Date:
Scheduled Meeting Time: From to
Number of Participants: (Attach List of Attendees and Affiliation)
Type of Meal (Check one): Lunch Dinner Other (Describe):
Purpose/Business Reason for Meal:
Meal is Within State Per Diem Rate: Meal Exceeds State Per Diem Rate:
If meal exceeds the State per diem rate, please explain why.
Approvals
___________________________________________________________ ____________________
Signature of Department Approver for Source of Funds Date
___________________________________________________________ ____________________
Agency Head/Designee Date
................
................
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