Employee Name:	Signature:	Date Submitted:
I certify that expenses listed below were incurred by me on official business of the Commonwealth of Virginia and include only such expenses as were necessary in the conduct of this business.
Date	Location	Time Left	Time Return	Over-night	Vendor	Item	Number of Miles	Vehicle Use Code (below)	Amount ($)
Purpose of Trip:	Conference	Presentation	Investigations	Education	Field Work	Other (explain)
Description:
Vehicle Use Code:	1. Personal Vehicle - Cost Beneficial to State – Personal Mileage Rate	2. State Vehicle - Not Available/Accessible – Personal Mileage Rate	3. State Vehicle - Available or Not Requested – Fleet Mileage Rate