Month & year for which you're requesting reimbursement:
Date of Travel Point of Origin Destination Round Trip? Miles Traveled
Board Policy reimburses mileage at $0.02 less than the IRS Mileage rate: https://www.irs.gov/tax-professionals/standard-mileage-rates
By submitting this form, I certify that I have traveled the above stated mileage on official business in the performance of my duties.
Section 2 -- To be completed by the Secretary or Bookkeeper: