REQUEST FOR INDIVIDUAL PAYMENT TO: 1 Speaker of the Senate Speaker of the House FROM: ( Senator O Representative DATE: = SUBJECT; Request for Travel Payment and Per Diem This is to request your approval of payment of travel and per diem of the recent meeting which | attended. Meeting: _ Date of Meeting: Place: TRAVEL: O Mileage: TO: _ FROM: _ miles at cents per 8 O Airline: Please attach passenger receipt or copy of ticket $. (including tickets charged to state credit card) D Lodging: ‘Only Room Rate & Tax Reimbursed (Applies to Out-of-State Lodging - Must have itemized receipt) O Parking: Ol Airport = _ Hotel (Must have receipt) $. O Taxi: 8. C1 Other: Please explain under remarks $. PER DIEM: days at $. ___ per day = s. (for LA office use only) REGISTRATION: Check One O Pre-Paid (© ReceiptEnclosed O To Be Billed $ TOTAL EXPENSES: (for LA office use only) & REMARKS: _ _ 2 oe APPROVED: Speaker Date’ - BY: _ Secretary or Submitter Extension For Legislative Administration Use Only ‘Submit to Speaker - KEEP GOLDENROD copy for your les : ‘ pia Spesers honest Voucher # APPROVED Wiite, Green copies: Logislatve Administration Canary copy Member's Ofce Amount Initials Pink Copy Speaker's Offco 1996:¢ Date Date