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["TESA TRAVEL and/or EXPENSE VOUCHER"]
["REIMBURSEMENT REQUEST"]
["PAY TO:"]
["Name: ",{"$nulls":4},"Period From:"]
["Attn: ",{"$nulls":4},"To:"]
["Address: ",{"$nulls":4},"TESA Officer or Committee"]
["City/ST/ZIP: ",{"$nulls":4},"TESA Account Nr"]
[]
["Complete form for areas related to your request for reimbursement, total, sign and date.\nFor travel claims use a separate voucher for each trip or attach summary."]
[]
["GL Per Diem Request (only TESA Officers/Cmte Mbrs required to & attending GL Session)?",{"$nulls":4},"Yes:",null,"No:"]
[]
["ITINERARY"]
["DATE","PLACE (City/State) ",null,null,"MILES (If Car) ","REASON FOR TRIP"]
[{"$nulls":4},0]
[{"$nulls":4},0]
[{"$nulls":4},0]
[{"$nulls":3},"TOTAL MILES",{"$f":"SUM(E15:E17)","v":0},"AUTH. RATE x MILES ="]
[null,null,"AUTHORIZED RATE:",{"v":0.4,"d":"$0.40"},{"$nulls":4},"TOTAL $ REQUESTED:",{"$f":"SUM(E18*D19)","v":0}]
["                                                      PER DIEM",{"$nulls":7},{"v":50,"d":"$50"},"per day"]
["NR DAYS","PLACE (City/State) ",null,null,"REASON FOR TRIP",{"$nulls":4},"TOTAL $"]
[{"$nulls":9},{"$f":"SUM(A22*I20)","v":0}]
[]
["AIR FARE (Receipt Required)"]
["DATE","PLACE (City/State) ",null,null,"REASON FOR TRIP",{"$nulls":4},"TOTAL $"]
[{"$nulls":9},0]
["LODGING (Receipt Required)"]
["DATE","HOTEL",null,null,"REASON FOR TRIP",{"$nulls":4},"COST"]
[{"$nulls":9},0]
[{"$nulls":9},0]
[{"$nulls":9},0]
[{"$nulls":9},0]
[{"$nulls":8},"TOTAL $ REQUESTED:",{"$f":"SUM(J29:J32)","v":0}]
["PURCHASED/MISCELLANEOUS ITEMS (Receipts Required)"]
["DATE","VENDOR","PRODUCT",null,"PURPOSE/USE",{"$nulls":4},"COST"]
[{"$nulls":9},0]
[{"$nulls":9},0]
[{"$nulls":9},0]
[{"$nulls":9},0]
[{"$nulls":9},0]
[{"$nulls":8},"TOTAL $ REQUESTED:",{"$f":"SUM(J36:J40)","v":0}]
[{"$nulls":8},"GRAND TOTAL OF REIMBURSEMENT:",{"$f":"SUM(J41+J33+J26+J22+J19)","v":0}]
["Under my Obligation as an Elk the requested reimbursement is for expenditures that were necessary and required solely for the discharge of my duties as a TESA Officer or Committee Member."]
["Submitted:",null,"Signature:",{"$nulls":4},"Date:"]
[]
[{"$nulls":3},"TESA Secretary Use Only",{"$nulls":5},"rev 3/2025"]
["App. By:",null,null,"Date:",{"$nulls":4},"Account Nr:",{"$f":"IF(G7=\"\",\"\",G7)","v":""}]
["Secy Sig:",null,null,"Vouche Nr:",{"$nulls":4},"Check Nr:"]