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expense report template new, pgs. 1 3 .pdf



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Expense Reimbursement Request

Corey Keltner

02/06/13

Payee Name

Expense Period Start Date

106 L Street, Suite 3
Payee Address

Sacramento

CA

City

State

Payee Signature

Date

95814
Zip

05/31/13
Expense Period End Date

05/31/13
Mapping, Staking, and Researching of Flying Dutchman Arizona Mining Claims.
Business Purpose for Expenses

Expense Date

02/06/13
02/06/13
02/06/13
02/06/13
02/06/13
02/07/13
02/08/13
02/08/13
02/08/13
02/08/13
02/08/13
02/08/13
02/09/13
02/09/13
02/09/13
02/09/13
02/10/13
02/10/13
02/10/13
02/11/13

Expense Description

Food:
McDonald's
Food:
Chevron
Fuel:
Chevron
Food:
Four Corners Union
Food:
Texaco
Work Supplies:
Ace Hardware
Food:
McDonald's
Work Supplies:
Lowe's
Work Supplies:
Lowe's
Food:
Terrible's
Fuel:
Texaco
Work Supplies:
Walmart
Food:
Burger King
Food:
Walmart
Food:
McDonald's
Food:
McDonald's
Food:
Taco Bell
Food:
Maya's Restaurant
Food:
Burger King
Food:
Burger King
Subtotal
Total Amount:
(expenses cont. on 2nd page)

Amount

$6.50
$10.84
$61.32
$5.08
$8.13
$25.74
$3.32
$8.05
$12.72
$10.39
$54.75
$14.69
$3.35
$8.10
$4.43
$4.21
$7.24
$19.50
$2.90
$5.92
$224.43

Office Use Only

Received by:

Reimbursement Approved:

Yes

Guy Wong-Denman
No

Name

Signature

Date

02/11/13
02/11/13
02/11/13
02/11/13
02/11/13
02/11/13
02/11/13
02/11/13
02/12/13
02/12/13
02/12/13
02/12/13
02/12/13
02/12/13
02/15/13
02/15/13
02/16/13
02/16/13

02/16/13
02/16/13

Research Copies: La Paz County Recorder
Research (Maps): La Paz County Recorder
Work Supplies:
Ace Hardware
Printing Fees:
A Plus Mail Center
Food:
McDonald's
Food:
Riverwalk Deli
Food:
Gift Shop
Food:
Riverwalk Deli
Lodging:
Bluewater Resort & Casino
Food:
Riverwalk Deli
Fuel:
Shell
Miscellaneous (Street Maps): Shell
Food:
Shell
Food:
Filiberto's
Fuel:
Chevron
Food:
Chevron
Food:
Arco am/pm
Fuel:
Arco am/pm
Car Rental:
Enterprise
Work Supplies:
Walmart
Subtotal Amount:

$2.00
$10.00
$27.51
$17.88
$3.32
$9.97
$3.25
$3.09
$67.20
$6.62
$47.21
$10.95
$2.00
$7.77
$49.86
$9.71
$7.89
$58.66
$449.46
$3.30
$797.65

3

Legal Fees: Richard Keith Corbin , Agreement, Pg. 1 & 2,
Receipt, Business Card (Front), Card (Back)
2/6/13 - 2/12/13 Subcontractor Fee: Corey Keltner ($150 a day x 6 days)
Subtotal Amount:
Total Amount:
04/12/13

Food:
Gift Shop
Food:
Riverwalk Deli
Lodging:
Bluewater Resort & Casino
Food:
Riverwalk Deli
Fuel:
Shell
Miscellaneous (Street Maps): Shell
Food:
Shell
Food:
Filiberto's
Fuel:
Chevron
Food:
Chevron
Food:
Arco am/pm
Fuel:
Arco am/pm
Car Rental:
Enterprise
Work Supplies:
Walmart
Subtotal Amount:

$825.00

$900.00
$1,725.00

$2,747.08


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