<p> 2017 REIMBURSEMENT OF TRAVEL ♦ Lakeview College of Nursing ♦ 903 North Logan Avenue ♦ Danville, Illinois 61832 ♦</p><p>NAME </p><p>DESTINATION/PURPOSE </p><p>LODGING Hotel/Motel ( Nights @ $ per night) $ </p><p>MEALS (Must submit each itemized receipt. No alcoholic drinks reimbursed) Breakfast Days @ $7.00 $ </p><p>Lunch Days @ $12.00 $ </p><p>Dinner Days @ $20.00 $ </p><p>(Prices shown are allotment per day/per meal. Example: if your breakfast costs $6.42; you only get reimbursed that specific amount…if your breakfast costs $8.20; you only get reimbursed the daily allotment of $7.00. Only 15% Gratuity will be reimbursed. Anything over allotment/gratuity will be the employee’s responsibility.)</p><p>TRANSPORTATION (must submit each itemized receipt) Air $ Airport parking $ Auto Miles @ $ .535 (IRS rate) $ Other (bus or train) $ Taxi $ Registration Fee (deduct any meals included from above meals allotment) $ Miscellaneous Reimbursement Expense (Itemize) $ $ $ </p><p>TOTAL$ </p><p>TOTAL AMOUNT ADVANCED $ </p><p>AMOUNT RETURNED TO COLLEGE $ </p><p>AMOUNT DUE TO EMPLOYEE FOR REIMBURSEMENT $ </p><p>I hereby certify that to the best of my knowledge the information furnished on this form is true and complete and I have attached all itemized receipts. I understand that if found to be otherwise, it is sufficient cause for rejection of reimbursement.</p><p>Signed Date </p><p>This form must be returned no later than 5 business days after returning to LCN. Submit completed form and all itemized receipts to the Assistant to the President. </p><p>*Attach all required itemized receipts.</p><p>**Including Gratuities Effective 01.01.16 </p>