ࡱ> KMJg bjbjVV 8Br<r<h  8,H:$0-QQQFQQQQ 9Q 0:Q4QQ<QQ: : NALS OF MICHIGAN EXPENSE/INCOME FORM FISCAL YEAR 2011-2012 Person Submitting: Address: Phone: Facsimile: Email: Dated Submitted: EXPENSE REIMBURSEMENT REQUESTINSTRUCTIONS: Separate expense reimbursement forms required for each line item. Copy receipts as necessary to accomplish this. Copies of all receipts detailing expense must be attached. Credit card receipts are not sufficient, you must have a cash register receipt or equivalent to prove expense.Expense Line Item: Approved by: (Signature of Officer or Committee Chair Required)Make Check Payable To: Send Check to: Description Of Expenses  $Mileage reimbursement shall be reimbursed for actual cost of gas to be submitted for reimbursement with a receipt. To figure actual cost of gas you start with a full tank of gas and refill the tank at the end of trip for the actual amount used. Total $ Treasurer to complete below this lineDate PaidCheck No.Over Budget Amount Yes NoApproved Yes NoDate posted to General Ledger INCOME STATEMENTINSTRUCTIONS: This form must accompany all funds turned into the treasurer. If more than one Line Item is to be credited on a single check, complete a separate income statement for each Line Item and attach all applicable income statements to check. If income is from sales, separate forms should be provided for each location.Income Line Item: $Total$Treasurer to complete: Date Posted to General LedgerSend to: Patricia A. 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