Expense Reimbursements

Instructions

1. Prepare any receipts for submission as either jpg or pdf files. (All receipts should be FINAL bills, not estimates).
2. Fill out all required fields and upload receipts through this form.
3. Click the “submit” button. You will receive a confirmation at the email you entered.

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Name *

Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Expense Period Begin

Expense Period End

Email *

Phone *

Board or Committee *Click to chooseBoard of TrusteesBoard for Christian ServiceBoard for Home OutreachBoard for Lutheran SchoolsBoard for World OutreachBoard for Youth OutreachBoard on ApologeticsCommittee for Archives & HistoryCommittee for CommunicationCommittee on NominationsCommittee on WorshipDoctrine CommitteeEqualization CommitteeMissions Advancement ProjectPlanning & Coordinating CommitteeSynod Review CommitteeCircuit VisitorsSynod StaffOther

Mileage

Total Mileage

Mileage Rate

Total Owed Mileage

Expense 1

Date (E1)

Choose One (E1)Click here to chooseMealsLodgingCar RentalAirfareOther

Total Spent (E1)

Expense 2

Date (E2)

Choose One (E2)Click here to chooseMealsLodgingCar RentalAirfareOther

Total Spent (E2)

Expense 3

Date (E3)

Choose One (E3)Click here to chooseMealsLodgingCar RentalAirfareOther

Total Spent (E3)

Expense 4

Date (E4)

Choose One (E4)Click here to chooseMealsLodgingCar RentalAirfareOther

Total Spent (E4)

Expense 5

Date (E5)

Choose One (E5)Click here to chooseMealsLodgingCar RentalAirfareOther

Total Spent (E5)

Total Reimbursement Owed

$0.00

Upload Images of Receipts (PDF or JPG ONLY)

Drag & Drop Files, Choose Files to Upload You can upload up to 20 files.

Comment or Message

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