Expense Account Statement

Dear Felix



Employee:
For period ending:

REIMBURSABLE EXPENSES INCURRED

Hotel/Lodging $100
Meals $50
Tax $12
Travel [air, train, bus] $66
Personal auto: __12__ miles x __33_ cents/mile = $500
Parking $121
Phone $33
Other [itemize]: $33
---------------------------------------------------------
Total: $1022

I certify the above is a true statement of incurred expenses in accordance with company policy. Receipts are attached.

Employee Approved for payment:

By:Lydia