North Carolina Women of the Elca

EXPENSE FORM NORTH CAROLINA WOMEN OF THE ELCA

Name______Date ______Address ______City ______Telephone ______Zip ______Event/Activity ______Expenses incurred for ______Person(s) traveling with you ______Committee(s) they serve on ______Food/Lodging______Honorarium ______Postage ______Phone ______Travel ______miles @ $.25= ______Travel (donated)______miles @ $.14 = ______Miscellaneous (specify) ______Total expenses incurred $______

Please designate the line item: _____ Administration (Board) _____ Discipleship _____ Justice _____ Stewardship _____ Conference Leader _____ Other ______Gathering Program Planning

Mail to: Nena Babb 6130 Heavner Road, Vale, NC 28168 _____ In lieu of reimbursement, please send me a receipt so that I can claim this amount as a contribution to Women of the ELCA.

------(For Treasurer’s use only)

Date Paid ______Check Number ______Comments ______Treasurer ______Revised 2/28/2017