Online Assembly Voucher Form Assembly Expense Voucher In order to be eligible for Travel Expense reimbursement, your name must appear on the assembly sign-in sheets. Name & Meeting Attended First Name * Last Name * Date of Meeting Contact Information Email * Mailing Address * Mailing Address Mailing Address Mailing Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Travel Expenses Total No. miles traveled Miles x 0.25 $ No. Additional Passengers No. miles with passengers Passengers x Miles x 0.03 $ Parking Expense $ Contribution Please deduct from the total travel expense the following sum, which I am hereby making as a contribution to the Presbytery of Ohio Valley. (The amount of your contribution will be included on your year-end giving statement.) Amount of Contribution $ Reimbursement If you are donating any of your expenses, add the amount in the "Contribution" field above. Total Travel Expense $ Less My Contribution - $ Total Reimbursement $ If you are human, leave this field blank. Submit
