Example 1

SUMMARY EXPENSE REPORT

To receive reimbursment, please follow the instructions outlined in the reimbursement

\NSGC guidelines. Submissions failing to adhere to these procedures may be delayed in the payout II process.

Mail Form and Receipts To:

Attn: Lisa Crumble

Carthage College

Wisconsin Space Grant Consortium

2001 Alford Park Drive

Kenosha,Wl53140

Contact the WSGC office with any questions.

spacegra nt@ca rthage .ed u

262.551.6054

Rcpt.# Date Vendor/Store

1

2

3

11 /9/16 Google Map

11/9/16 Brit's Pub

11 /9/16 Hyatt Regency

4 11/10/16 Hyatt Regency

5 11 /9/16 Kwik Trip

Please Make Check Payable To:

Name:

Address: Jane Doe 2001 Alford Park Drive

City, State, Zip: Kenosha, Wl53140

Requisitioner:

Jane Doe

Description Amount

Mileage to AISES Conference $ 429.78

Team Dinner $ 133.80

Conference Lodging $ 210.65

Conference Lodging $ 375.94

Fuel for Conference Travel $ 10.80

Total $ 1 160.97

REQUISITIONER STATEMENT: I declare all costs associated with this program are necesary and reasonable for this award,

following all applicable WSGC regulations. The expenses listed on this report were personally incurred.

Date Phone#

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Example 2

2001 Alford Park Dr, Kenosha, WI 53140 to

2001 Alford Park Dr, Kenosha, WI 53140

Drive 747 miles, 7 7 h 3 min

0

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Map data ©2017 Google

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20mi..__ ____ _

11 h 3 min

11 h 3 min without traffic

741 x $.58 = $429.78

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Example 3

1 , • r

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I I

0HYATT

REGENCY MINNEAPOLIS

INFORMATION INVOICE

Payee

Confirmation No. 2970196101

Group Name

Date

11-09-1611-09-1611-09-1611-10-16

Guest Signature

Description

Parking Overnight - Self Guest Room Occupancy Tax Visa

I agree that my liability for this bill is not waived and I agree to be held peraonally liable in the event that the indicated person, company or aaaoeiation falls to pay tor any part or the full amount of tneae cnarges.

-------------·· ---

. Hyatt Gold PaaportJ,Ufflll!�JY.

No Membership to be credited

Join Hyatt Gold Passport today and start earning points for stays, dining and more. Visit goldpassport,com

Example 4

Total

Balance

Hyatt Regency Minneapolis 1300 Nicollet Mall Minneapolis, MN 55403 T.1-612-370-1234F.1-612-370-1463www.mjnneapolis hyattcom

Room No.

Arrival

Departure

Page No. 1 of 1

Folio Window 1

Folio No.

Charges

19.00 169.00

22.65

210.65

0.00

Credits

Thank you for choosing the Hyatt Regency Minneapolis. We enjoyed having you as our guest. If, for any reason, we fell short of your expectations we want to know about it. Please call our Quality Assurance Department at 612-596-4685 or send your comments to aualitymsorm@hyattcom. Once again, thank you, we appreciate the opportunity to serve you.

For inquiries concerning your bill please call 405-912-4111.

Please remit payment to: Hyatt Regency Minneapolis PO Box 860122 Minneapolis, MN 55486-0122

INVOICE

Payee

HYATT REGENCY. MIN N: APO:.. IS

2801149501

Example 5 Hyatt Regency Minneapolis@) 1300 Nicollet Mall l J Minneapolis, MN 55403 \. T.1-612-370-1234 F.1-612-370-1463 www . minneapolis. hyatt.com

11-10-16

11-12-16

1 of 1

Folio Window Confirmation No.

Group Name

Booking No.

Am Indian Science & Eng Soc 2016

32GQTLN3

Folio No. 791242

Date

11-10-16 11-10-16 11-10-16 11-11-16 11-11-16 11-12-16

Guest Signature

Description

Parking Overnight - Self Group Room Occupancy Tax Group Room Occupancy Tax Visa

I agree that my llaOIIity for this 0111 is not wa1veo a no 1 agree to be held pe rsonally liable in the event 11a1 I he ind icated person , company or association fails to pay for any parlor the full amount of these charges.

_ttyatt Gold Pa~p_ort Summary

No Membership to be credited

Join Hyatt Gold Passport today and start earning points for stays. dining and more. Visit goldpassport.com

Charges Credits

38.00 149.00 19.97

149.00 19.97

375 .94

Total 375.94

Balance 0.00

Thank you for choosing the Hyatt Regency Minneapolis. We enjoyed having you as our guest. If, for any reason. we fell short of your expectations we want to know about it. Please call our Quality Assurance Department at 612-596-4685 or send your comments to gualitymsorm@hyatt com . Once again. thank you, we appreciate the opportunity to serve you.

For inqu iries concerning your bill please call 405-912-4111 .

Please remit payment to: Hyatt Regency Minneapolis PO Box 860122 Minneapolis, MN 55486-0 122

Example 6 Kt•lik Tt·ip

6 '107 3t-l Ddue(2\

J.teno111onie 0 \H 51f7 5 1

(715) 2:J!> - tl7 ~5

S to,. e II : 6 7,.

CAR \·lA H CODE: Code good at this location only . Please Use l•!ithin 31l Day!: _

OXY87 Pu111p Hul!lbet· Gallons Pdce/Gal Total Fuel

Total Sa Visa Fl

(17

s .1197 $2.119 $10.80

Uisa Fleet xxxxxxxxxx~x?~o~