Reimbursing Local Governments for COVID-19 Response Costs

For the calendar month of April 2020, please provide the following information relevant to your local unit of government:

Board Expense Form - Imported from MML.org

Part 1: Payee Information

Name: *

Municipality: *

Address for Reimbursement (including city/state/zip): *

(reimbursement will be sent to this location)

Email *

Purpose for Travel *

Begin Travel Date:

End Travel Date:

Reimbursement Payable To: *

Individual

Municipality

Part 2: Mileage

Total Miles Driven (round trip, must be greater than 100 miles per travel policy)

(Reimbursement will be calculated automatically minus the first 100 miles driven.)

Day 4 Lunch

Day 4 Dinner

Day 4 Total

Day 5 Breakfast

Day 5 Lunch

Day 5 Dinner

Day 5 Total

Total Meals Expense

(total of "Daily Total" column)

Part 4: Miscellaneous Travel Fees

(parking, taxi, hotel, etc.)

Description of Misc Travel Fee

Total Misc Travel Expense

Total Reimbursement

Part 5: Upload Receipts

File Upload

Maximum file size: 20.48MB

Part 5: Acknowledgement

I certify that the above expenses were all incurred while conducting League business in accordance to any applicable travel polices set forth by the Michigan Municipal League and have provided any applicable receipts as support to my reimbursement.

Signature *

Clear

Date

If you are human, leave this field blank.

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