COSHOCTON COUNTY
EXPENSE REPORT

Employee Name: __________________________________           Travel Dates       : ___________________________

Department       : __________________________________           Purpose of Travel: __________________________

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday	Totals	
Lodging									
  Hotels									
Meals  (Not to exceed $50 per day –tip reimbursement cannot exceed 20%)									
  Breakfast  									
  Lunch									
  Dinner									
                                  Total	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	
Mileage (Use of personal auto)									
  Actual Miles  	0	0	0	0	0	0	0		
  Rate per Mile	$0.535	$0.535	$0.535	$0.535	$0.535	$0.535	$0.535	---	
                            Subtotal	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	
  Parking & Tolls								$0.00	
                                  Total								$0.00	
Transportation									
  Airfare								$0.00	
  Taxis								$0.00	
  Auto Rental								$0.00	
  Gas								$0.00	
                                  Total	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	
Other (List or Attach List)								$0.00	
 									
                                                                                                                                  Total Due Employee	$0.00	

Attach copies of all receipts and copy of Commissioner’s Approval Form.
	
Employee Signature:  __________________________________________________ Date: ______________________

Authorized By        :  __________________________________________________ Date: ______________________