AURORA VOLUNTEER FIRE DEPARTMENT

VEHICLE USAGE REPORT

Reimbursement Form


Enter the requested information in the form below and submit for reimbursement from either the A.V.F.D. or the Aurora-Ledyard Fire District






Member Requesting Reimbursement

               Date of Travel (mm/dd/yy) / /

Purpose of Travel  

Finish Mileage       

Start Mileage         

Total Mileage         

* Receipts Must be Attached and Submitted

   Print and Sign Hard Copy for Submission
Mileage Reimbursement Due(Total Miles x Rate) $
(2007 IRS Mileage Rate $0.485 / Mile)                    

Tolls $

Parking $

Meals & Miscellaneous Expenses $

Total Amount Due to You $



   


Please enter the mailing address you would like your reimbursment sent to:

Address Line 1  

Address Line 2  

Address Line 3  








Members Signature                     






Date                            





Chief's Signature                       






Date