ࡱ> {}xyzy ,bjbj 8P{{]4>>LLLLL0L0L0L8hLM0LOccccc mLr$mALvccvvLLccYkkkvFLcLckvkknXcЩzvƓ(ޕo0(Wwx P$NLrlu0u"kuuuuuρ uuuvvvvuuuuuuuuu> J: TRAVEL VOUCHER FOR NON STATE EMPLOYEESVoucher NumberMichigan Department of Human ServicesInvoice NumberAudited ByINSTRUCTIONS:1A. Payee/Vendor Name2. Agency Number3. Checked By4. Page / of FORMTEXT      431 FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT       FORMTEXT      B. Address5. Payee Social Security Number5a. Mail Code6. Prepare Phone No.  FORMTEXT       FORMTEXT       FORMTEXT      ( FORMTEXT    )  FORMTEXT      C. CityD. StateE. Zip Code7. Date TraveledDate Traveled FORMTEXT       FORMTEXT    FORMTEXT      FROM: FORMTEXT      TO: FORMTEXT      8. Payee Type FORMCHECKBOX C.J.O. (FTR-18) FORMCHECKBOX STUDENT (FTR-18) FORMCHECKBOX CONTRACTUAL (FTR-18) FORMCHECKBOX VOLUNTEER (FTR-1632)9. Institution/organization (if applicable) FORMTEXT      10. Message11. Nature of Business Travel (Purpose/Description/Comments)TRAVEL EXPENSE REIMBURSEMENT FORMTEXT      12. Day of the Month13.14.Mileage18.Meals21. 22. List All Destinations Streets and Cities (All addresses from and to include every stop)DepartReturn15. Stand.16. Prem.17. Dollar AmountMotel or Room19. Non-Tax.20. TaxableOther Exp.DAILY TOTAL  FORMTEXT      FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar1+motel1+nontax1+tax1+oes1) 0.00.00 FORMTEXT     St: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar2+motel2+nontax2+tax2+oes2) 0.00.00 FORMTEXT     City: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar3+motel3+nontax3+tax3+oes3) 0.00.00 FORMTEXT      FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar4+motel4+nontax4+tax4+oes4) 0.00.00 FORMTEXT     St: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar5+motel5+nontax5+tax5+oes5) 0.00.00 FORMTEXT     City: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar6+motel6+nontax6+tax6+oes6) 0.00.00 FORMTEXT      FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar7+motel7+nontax7+tax7+oes7) 0.00.00 FORMTEXT     St: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar8+motel8+nontax8+tax8+oes8) 0.00.00 FORMTEXT     City: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar9+motel9+nontax9+tax9+oes9) 0.00.00 FORMTEXT      FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar10+motel10+nontax10+tax10+oes10) 0.00.00 FORMTEXT     St: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar11+motel11+nontax11+tax11+oes11) 0.00.00 FORMTEXT     City: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar12+motel12+nontax12+tax12+oes12) 0.00.00 FORMTEXT      FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar13+motel13+nontax13+tax13+oes13) 0.00.00 FORMTEXT     St: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar14+motel14+nontax14+tax14+oes14) 0.00.00 FORMTEXT     City: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT 0.00 FORMTEXT  =(dollar15+motel15+nontax15+tax15+oes15) 0.00.0023. COLUMN TOTAL 4 FORMTEXT  =sum(ABOVE) 0.00.00 FORMTEXT  =sum(ABOVE) 0.00.00 FORMTEXT  =sum(ABOVE) 0.00.00 FORMTEXT  =sum(ABOVE) 0.00.00 FORMTEXT  =sum(ABOVE) 0.00.00 FORMTEXT  =SUM(ABOVE) 0.00.00 FORMTEXT  =SUM(ABOVE) 0.00.00 FORMTEXT 024. VOUCHER TOTAL ....................4$ FORMTEXT  =sum(above) 0.00.0025. Payee SignatureDate26. State Employee Worker/Supervisor/CRC SignatureDatePrint NamePrint Name27. Worker/Supervisor/CRC Phone No. and Location  FORMTEXT      I certify that this travel was pre-approved, necessary to accomplish the DHS mission according to executive directive criteria, the most cost effective travel option available and that the items claimed represent proper charges. Check only one box below. FORMCHECKBOX 1. Legal or Federal Mandate FORMCHECKBOX 2. Health & Safety FORMCHECKBOX 3. Budget Savings FORMCHECKBOX 4. Mission Critical Administrative Travel28. Distribution Method29. Agency Code30. Approp. Year31. Index Code32. Program Cost Account (PCA)33. Agency Object Code (AOBJ)34. Distribution Code ($ Amount) FORMCHECKBOX SINGLE431 FORMTEXT    FORMTEXT       FORMTEXT       FORMTEXT      $ FORMTEXT 0.00 FORMCHECKBOX MULTIPLE431 FORMTEXT    FORMTEXT       FORMTEXT       FORMTEXT      $ FORMTEXT 0.00(Enter Dollar Amounts in Column 36)431 FORMTEXT    FORMTEXT       FORMTEXT       FORMTEXT      $ FORMTEXT 0.00431 FORMTEXT Llnpt h      * , . 0 2 4 6 J L N P R T V j ػ먳띳뒳뇳jnh`Ujh`Ujh`Ujh`Ujh`UjhgUmHnHujhT#Uh@wBjh@wBU h`CJ h`5h` hu CJ hfhu hu 0Nlnpr}w8$Ifmkd$$If940-+fd 4 9af4pyt0B$If .$Ifgd3d.$Ifrt$If+$Ifmkd$$If940-+fd 4 9af4pyt0B   tnhh8$If$Ifkd$$If94F-"+f     4 9af4pyt0B  D f h tnnnnn$Ifkdk$$If94F-"+f     4 9af4pyt0B  NH????? 8$$Ifa$8$Ifkd\$$If94r-"-'+f `bd  4 9af4pyt0B 4 T t v  : f $IfgdFfu 8$If$If 8$$Ifa$ j l n p r v x  & : h j ~ θڴΞҴΓҴΈҴjh_Uj, hT#Uj hT#UjN hT#U hh_hh_jhT#UjXhT#Uh@wBjh@wBUh`jhgUmHnHujh`Ujh`U.f h 0 vpppp8$Ifkd $$If94\-i"+f< b4 9af4pyt0B     " , . 2     * , @ B D N P Z \ p r t ~ ÿðÿðÿðÿðÿzh`CJOJQJjhT#UjhT#Uj hT#UjhT#Uh`jhT#Uh@wBjh@wBUhCjh_Uh_jhgUmHnHujh_Uj h_U00 2 B T l vpgg^^ $IfgdC $$Ifa$$Ifkd$$If94\-i"+f< b4 9af4pyt0B  * R Z smamWmWm  $If 8$$Ifa$gd@wB8$IfkdA$$If94r -"+& T w 4 9af4yt0B MG$Ifkdm$$If94֞ -"#+& T@ 4 9af4yt0B .R| 8$Ifgdy $Ifgdy?kdg$$If94++4 9af4yt0B   .0LNPR|~"&(<>@JL 4qmejh`Uh_jhEUmHnHujhEUhEjhEUh[+#j1hyh >CJUaJ#jhyh >CJUaJ#jIhyh >CJUaJ#jhyh >CJUaJhyh`CJaJjhyh`CJUaJh`&$'!$Ifkd$$If94 = w -S!"+vvNvv x$$$$4 9af4yt0B$&NPhyss$If?kdu$$If94++4 9af4yt0B8$If?kd$$If94++4 9af4yt0BFHPXrJAAA $$Ifa$Rkd$$If940-+fd4 9af4yt~8$If $$Ifa$Rkd$$If940-+fd4 9af4yt~468BDjlnTVXZnprz|~ĺ{ueujh@wBhT#CJU h`CJjh@wBhT#CJUh@wBh`CJjhgCJUmHnHujh@wBhT#CJU h@wBCJjh@wBCJUh`OJQJhh+hC h`CJh`jhgUmHnHujh`Uj_h`U'rz $$Ifa$:1%% $$Ifa$gd[+ $$Ifa$kd_$$If94ִK )$D'+ CCM    4 9af4yt~n|&2<TVX~Bh8$If dFfy $$Ifa$ $$Ifa$gdC 246>@BDXZ\dfhj~ſŧſŧſŧσ}peσ}hCJmHnHuj!hCJU hCJjhCJUj hXCJUjhXCJUhXCJmHnHujqhXCJU hXCJjhXCJU h`CJjhgCJUmHnHujh@wBCJUjh@wBhT#CJU#bdjlnpxz~ѷנzh#hChE5CJOJQJ^JaJjhECJUmHnHuj 'h@wBhECJU hECJjhECJUjM#hCJUj"hCJUj9"hCJU hCJ h`CJhCJmHnHujhCJUj!hCJU(|~$Jp..V|Ff. 8$IfgdC 8$IfgdEFf$8$If "$&:<>FHJL`bdlnpr~qj)hXCJUjK)hXCJUhXCJmHnHuj(hXCJU hXCJjhXCJUjS(h@wBhECJUj'h@wBhECJUjhECJUmHnHujhECJUjs'hECJU hECJ)  "*,.0DFѓуsjhECJUmHnHuj0h@wBhECJUjhECJUj,hCJUj,hCJUj+hCJUj*hCJU hECJhCJmHnHujg*hCJU hCJjhCJU- *,.0DFHRTVXlnpxz|~ti\j;3hXCJUhXCJmHnHuj2hXCJU hXCJjhXCJUjC2h@wBhECJUj1h@wBhECJUjhECJUmHnHujc1hECJU#hChE5CJOJQJ^JaJhE5CJOJQJ^JaJ hECJjhECJU$*,.68:<PRT\^`bvxڼԯڼԢڼԕڼԈڼڼ{ڼj6hCJUj5hCJUju5hCJUj4hCJUjW4hCJUhCJmHnHuj3hCJU hCJjhCJU hECJjhXCJUhXCJmHnHu0:`,T|:`*2Z 8$IfgdEFf B8$IfFf8 8$IfgdC(*,.BDFPRTVjlnxz|~߯ߟߏ߅rg߅hXCJmHnHuj<hXCJU hXCJjhXCJUj'<h@wBhCCJUj;h@wBhCCJUjS;h@wBhCCJUjhCCJUmHnHuj:h@wBhCCJU hCCJjhCCJU hECJjhCJU'*,.68:<PRT\^`bvxz׺я׺׺u׺j?hCJUjY?hCJUj>hXCJUhCJmHnHuj;>hCJU hCJjhCJUj=hXCJU hXCJ hCCJhXCJmHnHujhXCJUj=hXCJU.&(*24HJLVXZ\prt~ǷͧǕLjͧxͧhͧ^jhXCJUjsEh@wBhECJUj Eh@wBhECJUjDhECJU#hChE5CJOJQJ^JaJjhECJUmHnHuj)Dh@wBhECJU hECJjhECJU hCCJhCJmHnHujm@hCJUjhCJU$ 246>@BDXZ\dfhj~ҮҮvҮjHhCJUjHhXCJUhCJmHnHujGhCJU hCJjhCJUjFhXCJUjkFhXCJU hECJhXCJmHnHujhXCJUjEhXCJU hXCJ+Bh02Xd(Ntbd 8$IfFfUFfK 8$IfgdE "$,.24HJLTVXbdfz|~׺ת׋yl׺\jNh@wBhECJUjNhECJU#hChE5CJOJQJ^JaJhE5CJOJQJ^JaJjhECJUmHnHujNh@wBhECJUjhECJUjIhCJU hCJ hECJhCJmHnHujhCJUj/IhCJU$$&(*>@BJLNPdfhprtſŧſŧſŧ߃}pehCJmHnHujwQhCJU hCJjhCJUjPhXCJUj[PhXCJUhXCJmHnHujOhXCJU hXCJjhXCJUjcOh@wBhECJU hECJjhECJUmHnHujhECJU'tvHJPRTV^`dfz|~ǩǩǩǏǩхoj Xh@wBhCCJU hCCJjhCCJUjShCJUjShCJUhCJmHnHujRhCJU hCJjhCJU hECJhXCJmHnHujRhXCJU hXCJjhXCJU%~      $ & ( * > @ B J L N P d f h p ঠঠ{ঠnjZhXCJUj?ZhXCJUhXCJmHnHujYhXCJU hXCJjhXCJUjGYh@wBhCCJUjXh@wBhCCJUjsXh@wBhCCJU hCCJjhCCJUjhCCJUmHnHu+ ( N t !!!!!!"0"V"|""""#:#####$Ffh 8$IfgdEFf)_8$Ifp r t v !! ! !!"!$!n!p!v!x!z!|!!!!!!ߜߏxr hECJjhECJUj]hCJUj]hCJUjy\hCJUhXCJmHnHuj[hXCJU hXCJhCJmHnHuj[[hCJU hCJjhCJU hCCJjhXCJU,!!!!!!!!!!!!!!!!!!""" "" ""","."0"2"F"H"J"R"T"V"X"l"ϽϰϠϐφshφhXCJmHnHujbhXCJU hXCJjhXCJUjbh@wBhECJUj)bh@wBhECJUjahECJU#hChE5CJOJQJ^JaJ hECJjhECJUmHnHujhECJUjIah@wBhECJU$l"n"p"x"z"|"~""""""""""""""""""""""#######*#,#.#6#8#:#<#P#R####׺я׺׺u׺jOfhCJUjehCJUj5ehXCJUhCJmHnHujdhCJU hCJjhCJUjdhXCJU hXCJ hECJhXCJmHnHujhXCJUjchXCJU.#################$$$$$$$($*$,$6$8$:$<$P$R$T$^$`$b$׽ͭמͭoͭ_ͭjlh@wBhECJUjlh@wBhECJUjkhECJU#hChE5CJOJQJ^JaJhE5CJOJQJ^JaJjhECJUmHnHuj9kh@wBhECJUjhECJU hECJhCJmHnHujfhCJUjhCJU$$:$b$$$$$ %F%l%%%&8&`&&&&& 'F'l''((@(H(Ffc|8$IfFfr 8$IfgdEb$d$x$z$|$$$$$$$$$$$$$$$$$$$$$$$$$$%%%%% %"%6%8%:%B%D%F%H%\%ѭѭuѭjohCJUj%ohXCJUhCJmHnHujnhCJU hCJjhCJUjnhXCJUj{mhXCJU hECJhXCJmHnHujlhXCJU hXCJjhXCJU,\%^%`%h%j%l%n%%%%%%%%%%%%%&&& &&&&&&(&*&4&6&8&:&N&P&R&\&^&`&b&v&׺tjuh@wBhCCJUjuh@wBhCCJUjhCCJUmHnHuj)uh@wBhCCJU hCCJjhCCJUjphCJU hCJ hECJhCJmHnHujhCJUj?phCJU(v&x&z&&&&&&&&&&&&&&&&&&&&&&&&&&''''' '"'6'ſŧſŧſŧσ}peſhCJmHnHujxhCJU hCJjhCJUjwhXCJUjawhXCJUhXCJmHnHujvhXCJU hXCJjhXCJU hCCJjhCCJUmHnHujhCCJUjgvh@wBhCCJU#6'8':'B'D'F'H'\'^'`'h'j'l'n'''''''''''((( ( (((((0(2(4(<(>(@(ǺͯǢ͕ͯͯͯ׋uejhECJUmHnHuj~h@wBhECJU hECJjhECJUjzhCJUj/zhCJUhCJmHnHujyhCJU hCJjhCJU hCCJhXCJmHnHujhXCJUjyhXCJU&@(H(J(^(`(b(l(n(p(r(((((((((((((((((((((((()) ) ))")ݰݠݖxݖkxݖjǀhXCJUhXCJmHnHuj7hXCJU hXCJjhXCJUjh@wBhECJUjch@wBhECJUjhECJUmHnHuj~hECJU hECJjhECJU#hChE5CJOJQJ^JaJ&H(p(((( )2)X)~)))P*R*x*****"+H+n++++,,,FfQFfG 8$IfgdE")$)&).)0)2)4)H)J)L)T)V)X)Z)n)p)r)z)|)~))))))))))))))))))6*8*>*@*Ǻͯ詜Ǐͯǂͯxrxrxgxh-+CJmHnHu h-+CJjh-+CJUjhCJUj hCJUjwhXCJU hXCJhCJmHnHujhCJU hCJjhCJU hECJhXCJmHnHujhXCJUjUhXCJU(@*B*D*L*N*R*T*h*j*l*t*v*x************************׽ͭמͭoͭ_ͭj׉h@wBhECJUjmh@wBhECJUjhECJU#hChE5CJOJQJ^JaJhE5CJOJQJ^JaJjhECJUmHnHujh@wBhECJUjhECJU hECJh-+CJmHnHujh-+CJUj!h-+CJU#**++++ +"+$+8+:+<+D+F+H+J+^+`+b+j+l+n+p+++++++++++++++++++++ѭѭujhCJUjhXCJUhCJmHnHujhCJU hCJjhCJUj_hXCJUjъhXCJU hECJhXCJmHnHujAhXCJU hXCJjhXCJU*+++++,,,,,,r,t,z,|,~,,,,,,,,,,,,,,,,,,,,,,,-----Ѻtjkh@wBhCCJUjh@wBhCCJUjhCCJUmHnHujh@wBhCCJU hCCJjhCCJUj+h-+CJU hECJh-+CJmHnHujh-+CJU h-+CJjh-+CJU*,,,-,-R-x----.6.....//R/T/V/`/b/d/f/z/|/~///////////ylyj5hXCJUhXCJmHnHujhXCJU hXCJjhXCJUj;h@wBhECJUjќh@wBhECJUj[hECJU#hChE5CJOJQJ^JaJ hECJjhECJUjhECJUmHnHu'////////////////0000 0"0$080:0<0D0F0H0J0^0`0b0j0l0n0p00000Ѻхrgхh-+CJmHnHujh-+CJU h-+CJjh-+CJUjwhCJUhXCJmHnHujhXCJU hXCJjhXCJUjUhCJU hECJhCJmHnHujÞhCJU hCJjhCJU(000000000 111111&1(1*1>1@1B1L1N1P1R1f1h1j1t1v1x1z1111111׽ͭמͭoͭ_ͭjEh@wBhECJUjۦh@wBhECJUjehECJU#hChE5CJOJQJ^JaJhE5CJOJQJ^JaJjhECJUmHnHujh@wBhECJUjhECJU hECJjh-+CJUjh-+CJUh-+CJmHnHu%001(1P1x1111282^2220323j334N44425~558$If$($Ifa$gdEFf 8$IfgdEFf11111111111111112222222(2*2,2426282:2N2P2R2Z2\2^2`2t2v2x2222ѺujhCJUjhCJUj_hCJUhXCJmHnHujͨhXCJU hXCJjhXCJUj?hCJU hECJhCJmHnHujhCJU hCJjhCJU*22222222222333 3"3$3,3.323f3h3j3l333333333333333333333344vjhCJU hCCJjhCJUhCJmHnHu hCJjhCJUhChECJOJQJaJhCjh-+CJU hECJh-+CJmHnHuj h-+CJU h-+CJjh-+CJU.44444464<4>4@4B4J4L4N4P4d4f444444444444444444444444455 5"5$5&5.5052545H5J5d5f5l5n5p5r5z5|5~5jhCJUjhCJUj}hCJUj߱hCJU hCCJj?hCJUhCJmHnHu hCJjhCJU<~555555555555666062686:6<6>6F6H6L6277777ľ|xcShEhE5CJOJQJ^J(jhEhE5CJOJQJU^JhE hEhEjoh-+CJUh-+CJmHnHu h-+CJjh-+CJUhChChCCJOJQJaJ hCCJhCCJOJQJhC<CJmHnHu"jQhgghC<CJU hC<CJjhC<CJU555' 8$$Ifa$kdɴ$$If94 _(!$C'+UCCCCCL $$$$4 9af4yt~5555555J6 8$IfgdE8$IfJ6L6t6~66:11( $IfgdC $IfgdT#kd$$If94ִ(!$%C'+CCL     4 9af4yt~6666666}xkd$$If94\Y%+ 4 9af4yt0B $IfgdT#667&7(7}}*Rkd$$If940Y+C4 9af4yt0B $IfgdT#xkd$$If94\Y%+ 4 9af4yt0B(7*7,7.7072777}tfd8($IfgdE $IfgdExkd$$If94\Y%+ 4 9af4yt0B $IfgdT#7777777788888899!9"9#9$97989F9G9H9I9[9\9j9ӹө}m}}]}}M}}jhD8hCCJUj|hD8hCCJUjhD8hCCJUhxnhCCJjhxnhCCJUhxnhC5hChECJOJQJhEhE5CJOJQJ^J3jhEhE5CJOJQJU^JmHnHu(jhEhE5CJOJQJU^J.j۹hEhE5CJOJQJU^J7777777=xkd$$If94\Y%+ 4 9af4yt~ $IfgdT#?kdQ$$If94P++4 9af4yt0B78889$979I9[9m9999{ $IfgdT#Ffod8$Ifgd[r 8$Ifgd[rOkd{$$If94P++  4 9af4p ytC dL$Ifgdxn j9k9l9m99999999999::@:B::::::::::::::::;;;;;;;,;.;0;:;··՝Ւ՝y՝njhCUjhCUjhCUmHnHujhCUjhCU#jhyhCCJUaJhyhCCJaJjhyhCCJUaJhEhChxnhCCJjhxnhCCJUjdhD8hCCJU+9999999999: :>:F:j::$($Ifa$gdE$($Ifa$gdu ($Ifgdu?kd$$If94++4 9af4yt::::::::MG>>>>> $$Ifa$$Ifkd$$If94֞w c#+$),4 9af4yt:::::D8/ $Ifgd&m 8$$Ifa$gd&mkd$$If94֞w c#+$),4 9af4yt $$Ifa$:::;>;f;j;; 8$Ifgdf $Ifgdf 8$$Ifa$gdf 8$$Ifa$gd[r:;<;>;@;T;V;X;b;d;j;l;;;;;;;;;;;;;;;;;;;<<<<<<&<(<*<,<@<B<D<N<P<R<T<󷬚tjhCUj0hCUjhCU hC5#jFhyhCCJUaJhyhCCJaJjhyhCCJUaJhCmHnHujhCUjhCUmHnHujhhCUhCjhCU-;;;' $$Ifa$gd&mkdn$$If94  w c#$+Uo$)3$$$$4 9af4yt;;;;;;; $$Ifa$ $$Ifa$gdf $$Ifa$gd[r;;;;;MA8, 8$$Ifa$gd[r $Ifgd&m 8$$Ifa$gd&mkd$$If94֞w c#+$)34 9af4yt;<*<R<z<~<< 8$Ifgdf $Ifgdf 8$$Ifa$gdfT<h<j<l<v<x<~<<<<<<<<== == ="=&=(=*=,=@=B=D=N=P=R=T=h=j=l=v=x=z=|==================jhCUj&hCUjhCUjRhCUjhCU hC5hCmHnHujnhCUjhCUmHnHujhCUjhCUhC6<<<'!$Ifkd $$If94  w c#$+Uo$)3$$$$4 9af4yt<<<<<<< $$Ifa$ $$Ifa$gd[r<<<==MD>2 8$$Ifa$gd[r$If 8$$Ifa$kd.$$If94֞w c#+$)34 9af4yt=*=R=z====8$If $$Ifa$ 8$$Ifa$gdf==='!$Ifkd,$$If94 w c#$+Uo$)3$$$$4 9af4yt======= $$Ifa$ $$Ifa$gdf $$Ifa$gd[r=====MD>2 8$$Ifa$gd[r$If 8$$Ifa$kdV$$If94֞w c#+$)34 9af4yt==> "$&0246JLNXZ\^rtvjhCUjYhCU hC5hCmHnHujhCUjbhCUjhCUjhCUjhCUmHnHujhCUUhCjhCU5   FORMTEXT       FORMTEXT       FORMTEXT      $ FORMTEXT 0.00NOTE: DO NOT use the coding portion if more than 6 line  Use the Supplemental Coding Record DHS-4745431 FORMTEXT    FORMTEXT       FORMTEXT       FORMTEXT      $ FORMTEXT 0.00431 FORMTEXT    FORMTEXT       FORMTEXT       FORMTEXT      $ FORMTEXT 0.0035. TOTALS 4$ FORMTEXT  =(Distribution1+Distribution2+Distribution3+Distribution4+Distribution5+Distribution6) 0.00.00 INSTRUCTIONS- THIS FORM IS TO BE USED ONLY BY NON-STATE EMPLOYEES; PLEASE SEE 1582-TV FOR STATE EMPLOYEE TRAVEL VOUCHER: Travel related information is available in the DHS Administrative handbook Section Series 800. Improper or incomplete Travel Vouchers may be returned and require resubmission. It is especially important to assure the account coding structure is accurate and that the travel voucher is properly authorized. The payee address cannot be a DHS location. 1A Enter last name, first name, middle initial. Thirty characters are allowed for Payee name. Verify that Payee/Vendor is registered in MAIN. 1B Enter address. 1C Enter city name in full unless a commonly used abbreviation such as N.Y. for New York, etc., is recognized. 1D Enter the two-digit abbreviation only. DO NOT USE full state name. 1E Enter zip code. 2 Enter Index Code after 431, EXCEPT for Residential Cares and Institutions which have been assigned special Dept. No. 3 Initials of person that checks the voucher. 4 Enter page number of document(s). Use DHS SUPPLEMENTAL CODING RECORD (DHS-4745) if needed. 5 Enter payee s full 9 digit Social Security Number. 6 Enter preparer s phone number. 7 FROM: Enter begin travel month and date. TO: Enter end travel month and date. 8 Check appropriate box. Only 1. 9 Institution/organization (if applicable). 10 DO NOT USE - MESSAGE IS PREPRINTED. 11 Enter nature of business travel for this period (Purpose/Description/Comments). 12 Enter date of travel. 13 The description includes the departure and return destinations as well as all stops between departure and return. Client name, address and case #. Attach a MapQuest print showing each stop. If MapQuest is unavailable include the address with city and state for each stop. The description may be the departure and return to the local office of the department, the size of volunteer activity/event, or the client s home. When a client s home, indicate client s last name, address and case number. Indicate the nature of business requiring travel and specify departure and destination include city of call. 14 Enter time of departure and return for each trip to substantiate meal, lodging and any day care charges. 15-17 Enter MILEAGE* for the use of privately owned cars on state business. Enter the number of map miles traveled using MapQuest rounding to the nearest whole mile. Vicinity mileage in connection with the trip is allowable when shown as a separate item on the voucher. Multiply total miles by applicable reimbursement rate and enter in dollar amount column. *Refer to departmental guidelines or procedures of guidance in the use of the standard and premium mileage rates. 18 Enter the actual lodging cost but not to exceed the current state rate. Receipts for lodging expenses are required when reimbursement is requested on an actual basis. 19-20 Enter total for meal(s) per day. Non-taxable indicate those meals you paid when your trip included overnight lodging. Taxable indicate those meals you paid for when you did not have overnight lodging. 21 Itemize and identify dollar amounts of the other expenses, e.g., bus fare. Receipts for registration, child care, and parking expenses, etc., except meter parking, are required by the Standardized Travel Regulations. (Meter parking costs will be identified by entering M.P.). 22 Enter the total, per day, of columns 19, 20, 21, 22 and 23. NOTE: Within the block containing columns 14 thru 24, when charging the premium mileage rate, you must indicate one of the authorized circumstances for such charge as listed in Item 812 of the Administrative Handbook. 23 Enter totals of Columns 17, 18, 19, 20, 21, 22, 23, 24. 24 Enter total of Column 24. 25 Payee, sign and date. - ORIGINAL SIGNATURE IS REQUIRED. Print name under original signature. 26 Original Signature of the individual authorizing payment. Signature stamps are not acceptable. Print or type the individual s name below the signature. Enter date the voucher was signed. 27 State Employee Local Office (Worker) Name & Phone No. Verifying Expenses. Grey When signing the travel voucher, you are verifying that the travel was pre approved and necessary to accomplish the DHS mission Shaded according to the executive directive criteria. You must check only one of the four categories certifying that costs have been Area incurred in accordance with Executive Directive 2007-19 Travel Moratorium. CODING INSTRUCTIONS: Assure that the Index Code, Program Cost Account, Agency Object are correct. All coding must pass an edit. Incompatible coding will error out. 30 Enter appropriation year. 31 Enter the Index Code to which the expenditure should be charged. This MUST be compatible with the PCA #. 32 Enter the Program Cost Account to which the expenditures should be charged. Use a Supplemental Coding record, if more than 6 lines are used. ALL coding if more than 6 lines, must be on the Supplemental Coding record. 33 Enter the Agency Object Code to identify the type of travel expenses incurred. 34 Enter the amount charged to each account structure. 35 Enter the total amount paid, the sum of all lines of entry in box 36.AUTHORITY: 42 CFR; and Public Act 280 of 1939, as amended. RESPONSE: Voluntary. PENALTY: NoneDepartment of Human Services (DHS) will not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, sex, sexual orientation, gender identity or expression, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your area.     DHS-1582-TV-NSE (Rev. 9-11) Previous edition obsolete. MSWord  PAGE 1 Distribution: Original  Send to DHS Accounting Retain copy for your files = 4\8$If $$Ifa$ 8$$Ifa$gdf~' ($Ifgdukdh$$If94  w c#$+Uo$)3$$$$4 9af4yt~ $$Ifa$ $$Ifa$gdf $$Ifa$gd[rMG;// 8$$Ifa$gdf 8$$Ifa$gd[r$Ifkd$$If94֞w c#+`$)34 9af4yt  ",.46JLNVXZ\lnvx *jhCUjOhCUjhCUjohCU hC5hCmHnHuj hCUjhCUjhCUmHnHujhCUj9hCUhC604Z8$If $$Ifa$ 8$$Ifa$gdfZ\^`:4( $$Ifa$gd[r$Ifkd$$If94 ִw c#$+ $)3    4 9af4yt`bdfhjl8kd$$If94֞w c#+ $)34 9af4yt $$Ifa$ $$Ifa$gdflnv:8$If $$Ifa$ 8$$Ifa$gdf 8$$Ifa$gd[r$If*,.68:<>@dfln46<>@BJLPD"\lr:   * : t   f|@h|".  ߸hhthtCJaJhthfhuhrkhxdhUNhxnh`jhCUhChECJOJQJaJhE hC5hChCmHnHujhCUj#hCU7:<hl:,# $$Ifa$$($Ifa$gdEkd$$If94 ִw c#$+$)3    4 9af4ytlNPRT$H&$If6gd| dekd$$If94 F#$+$    4 9af4yt8$If"F,n   P6,Z<|0$If^`0$If|",    "T",#$%%&&<kd$$If$-++4 $aytrk $Ifgdf0$If^`0$If0$If^`0gd0$If^`0gdf  !!!""""T"X",#.#0#$$%%%%&&&&P'***********N+P+\+^+`+b+d+++++,, h5h~0J5mHnHu h0J5jh0J5UhhFjhFUhUh`hhB:hrk^JaJ h`v5h`v h`5hEhfhxnh`5h`hxn0&&&'2'P'****WUUOkdn$$IfHh0d++4 Haytrk$$Ifa$gd.5$If:kd$$If$++4 $aytrk $Ifgd`v ********+++,,  0**gd|  0*gd|  6&P/R :prk/ =!"#$% $$If!vh#vf#vd:V 94 +,5f5d/  / 44 9f4pyt0B$$If!vh#vf#vd:V 94 +,5f5d/ / 44 9f4pyt0B$$If!vh#vf#v#v:V 94 ,5f55/  / 44 9f4pyt0B$$If!vh#vf#v#v:V 94 ,5f55/ / / 44 9f4pyt0B@$$If!vh#vf#v #v#vb#vd:V 94  +,,5f5 55b5d/  / / /  / / 44 9f4pyt0BtD#Text4tDText6tDText7tDText8tDText9vDText10vDText14vDText15/$$If!v h#vf#vv#v)#v#vv#vx#v v#v #v b#v d:V 94+ 5f5v5)55v5x5 v5 5 b5 d/ /  / / / / 44 9f4yt0BkdD$$If94  -{i"-'+fvvv)vxv bd00004 9af4yt0B$$If!vh#vf#v< #vb#v:V 94,5f5< 5b5/  44 9f4pyt0BtD#Text5jDvDText33vDText11vDText12$$If!vh#vf#v< #vb#v:V 945f5< 5b5/ 44 9f4pyt0B$$If!vh#v& #v#vT#v #vw :V 94,5& 55T5 5w /  / / /  / 44 9f4yt0BvDText25vDText26vDText27vDText28vD Text29$$If!vh#v& #v#vT#v#v@ #v#v:V 94,5& 55T55@ 55/ / / /  / 44 9f4yt0Bl$$If!vh#v+:V 94,5+/  44 9f4yt0BtDeCheck1tDeCheck4tDeCheck3tDeCheck2$$If!v h#vv#vN#vv#v#vv#v #vx#v :V 94, 5v5N5v55v5 5x5 / /  / 44 9f4yt0Bl$$If!vh#v+:V 94,5+/  44 9f4yt0BvDMText13l$$If!vh#v+:V 94,5+/ 44 9f4yt0Bz$$If!vh#vf#vd:V 94,5f5d/  44 9f4yt~vD(Text30$$If!vh#vf#vd:V 94,5f5d/  / 44 9f4yt~'$$If!vh#v#v#v#v #vC#v#vC#vM:V 94+,5555 5C55C5M/ / / / / / / 44 9f4yt~$$If!v h#v#v#v#vM#vC#vD#vC#v #v C#v M:V 94{+, 5555M5C5D5C5 5 C5 M/ 44 9f4yt0Bkd$$If94{  K _)!$D'+MCCDCCM00004 9af4yt0BvDText16vD Text17vDText18vDText19DHstand10.00#,##0.00DHPrem10.00#,##0.00DHdollar10.00#,##0.00DHmotel10.00#,##0.00DHnontax10.00#,##0.00DHtax10.00#,##0.00DHoes10.00#,##0.00D*daily1#=(dollar1+motel1+nontax1+tax1+oes1)#,##0.00$$If!v h#v#v#v#vM#vC#v #v C#v L:V 94 , 5555M5C5 5 C5 L/ 44 9f4ytkd$$$If94  K _(!$C'+MCCCCCL 00004 9af4ytjDvD Text34jDjDDHstand20.00#,##0.00DHPrem20.00#,##0.00DHdollar20.00#,##0.00DHmotel20.00#,##0.00DHnontax20.00#,##0.00DHtax20.00#,##0.00DHoes20.00#,##0.00D*daily2#=(dollar2+motel2+nontax2+tax2+oes2)#,##0.00L$$If!v h#v#v#v#v#vM#v C#v #v C#v L:V 94 , 55555M5 C5 5 C5 L/ / / / / /  / / / 44 9f4ytDkde-$$If94" K _(!$C'+MCCCCCL 44444 9af4ytjDvD Text34jDjDDHstand30.00#,##0.00DHPrem30.00#,##0.00DHdollar30.00#,##0.00DHmotel30.00#,##0.00DHnontax30.00#,##0.00DHtax30.00#,##0.00DHoes30.00#,##0.00D*daily3#=(dollar3+motel3+nontax3+tax3+oes3)#,##0.00L$$If!v h#v#v#v#v#vM#v C#v #v C#v L:V 94 , 55555M5 C5 5 C5 L/ / / / / /  / / / 44 9f4ytDkdU7$$If94" K _(!$C'+MCCCCCL 44444 9af4ytjDjD jDjDDHstand40.00#,##0.00DHPrem40.00#,##0.00DHdollar40.00#,##0.00DHmotel40.00#,##0.00DHnontax40.00#,##0.00DHtax40.00#,##0.00DHoes40.00#,##0.00D*daily4#=(dollar4+motel4+nontax4+tax4+oes4)#,##0.00$$If!v h#v#v#v#vM#vC#v #v C#v L:V 94 , 5555M5C5 5 C5 L/ 44 9f4ytkd9A$$If94  K _(!$C'+MCCCCCL 00004 9af4ytjDvD Text34jDjDDHstand50.00#,##0.00DHPrem50.00#,##0.00DHdollar50.00#,##0.00DHmotel50.00#,##0.00DHnontax50.00#,##0.00DHtax50.00#,##0.00DHoes50.00#,##0.00D*daily5#=(dollar5+motel5+nontax5+tax5+oes5)#,##0.00L$$If!v h#v#v#v#v#vM#v C#v #v C#v L:V 94 , 55555M5 C5 5 C5 L/ / / / / /  / / / 44 9f4ytDkdJ$$If94" K _(!$C'+MCCCCCL 44444 9af4ytjDvD Text34jDjDDHstand60.00#,##0.00DHPrem60.00#,##0.00DHdollar60.00#,##0.00DHmotel60.00#,##0.00DHnontax60.00#,##0.00DHtax60.00#,##0.00DHoes60.00#,##0.00D*daily6#=(dollar6+motel6+nontax6+tax6+oes6)#,##0.00L$$If!v h#v#v#v#v#vM#v C#v #v C#v L:V 94 , 55555M5 C5 5 C5 L/ / / / / /  / / / 44 9f4ytDkduT$$If94" K _(!$C'+MCCCCCL 44444 9af4ytjDjD jDjDDHstand70.00#,##0.00DHPrem70.00#,##0.00DHdollar70.00#,##0.00DHmotel70.00#,##0.00DHnontax70.00#,##0.00DHtax70.00#,##0.00DHoes70.00#,##0.00D*daily7#=(dollar7+motel7+nontax7+tax7+oes7)#,##0.00$$If!v h#v#v#v#vM#vC#v #v C#v L:V 94 , 5555M5C5 5 C5 L/ 44 9f4ytkdY^$$If94  K _(!$C'+MCCCCCL 00004 9af4ytjDvD Text34jDjDDHstand80.00#,##0.00DHPrem80.00#,##0.00DHdollar80.00#,##0.00DHmotel80.00#,##0.00DHnontax80.00#,##0.00DHtax80.00#,##0.00DHoes80.00#,##0.00D*daily8#=(dollar8+motel8+nontax8+tax8+oes8)#,##0.00L$$If!v h#v#v#v#v#vM#v C#v #v C#v L:V 94 , 55555M5 C5 5 C5 L/ / / / / /  / / / 44 9f4ytDkdg$$If94" K _(!$C'+MCCCCCL 44444 9af4ytjDvD Text34jDjDDHstand90.00#,##0.00DHPrem90.00#,##0.00DHdollar90.00#,##0.00DHmotel90.00#,##0.00DHnontax90.00#,##0.00DHtax90.00#,##0.00DHoes90.00#,##0.00D*daily9#=(dollar9+motel9+nontax9+tax9+oes9)#,##0.00L$$If!v h#v#v#v#v#vM#v C#v #v C#v L:V 94 , 55555M5 C5 5 C5 L/ / / / / /  / / / 44 9f4ytDkdq$$If94" K _(!$C'+MCCCCCL 44444 9af4ytjDjD jDjDDHstand100.00#,##0.00DHPrem100.00#,##0.00DHdollar100.00#,##0.00DHmotel100.00#,##0.00DHnontax100.00#,##0.00DHtax100.00#,##0.00DHoes100.00#,##0.00D*daily10(=(dollar10+motel10+nontax10+tax10+oes10)#,##0.00$$If!v h#v#v#v#vM#vC#v #v C#v L:V 94 , 5555M5C5 5 C5 L/ 44 9f4ytkd{$$If94  K _(!$C'+MCCCCCL 00004 9af4ytjDvD Text34jDjDDHstand110.00#,##0.00DHPrem110.00#,##0.00DHdollar110.00#,##0.00DHmotel110.00#,##0.00DHnontax110.00#,##0.00DHtax110.00#,##0.00DHoes110.00#,##0.00D*daily11(=(dollar11+motel11+nontax11+tax11+oes11)#,##0.00L$$If!v h#v#v#v#v#vM#v C#v #v C#v L:V 94 , 55555M5 C5 5 C5 L/ / / / / /  / / / 44 9f4ytDkd$$If94" K _(!$C'+MCCCCCL 44444 9af4ytjDvD Text34jDjDDHstand120.00#,##0.00DHPrem120.00#,##0.00DHdollar120.00#,##0.00DHmotel120.00#,##0.00DHnontax120.00#,##0.00DHtax120.00#,##0.00DHoes120.00#,##0.00D*daily12(=(dollar12+motel12+nontax12+tax12+oes12)#,##0.00L$$If!v h#v#v#v#v#vM#v C#v #v C#v L:V 94 , 55555M5 C5 5 C5 L/ / / / / /  / / / 44 9f4ytDkd$$If94" K _(!$C'+MCCCCCL 44444 9af4ytjDjD jDjDDHstand130.00#,##0.00DHPrem130.00#,##0.00DHdollar130.00#,##0.00DHmotel130.00#,##0.00DHnontax130.00#,##0.00DHtax130.00#,##0.00DHoes130.00#,##0.00D*daily13(=(dollar13+motel13+nontax13+tax13+oes13)#,##0.00$$If!v h#v#v#v#vM#vC#v #v C#v L:V 94 , 5555M5C5 5 C5 L/ 44 9f4ytkd$$If94  K _(!$C'+MCCCCCL 00004 9af4ytjDvD Text34jDjDDHstand140.00#,##0.00DHPrem140.00#,##0.00DHdollar140.00#,##0.00DHmotel140.00#,##0.00DHnontax140.00#,##0.00DHtax140.00#,##0.00DHoes140.00#,##0.00D*daily14(=(dollar14+motel14+nontax14+tax14+oes14)#,##0.00L$$If!v h#v#v#v#v#vM#v C#v #v C#v L:V 94 , 55555M5 C5 5 C5 L/ / / / / /  / / / 44 9f4ytDkdg$$If94" K _(!$C'+MCCCCCL 44444 9af4ytjDvD Text34jDjDDHstand150.00#,##0.00DHPrem150.00#,##0.00DHdollar150.00#,##0.00DHmotel150.00#,##0.00DHnontax150.00#,##0.00DHtax150.00#,##0.00DHoes150.00#,##0.00D*daily15(=(dollar15+motel15+nontax15+tax15+oes15)#,##0.00L$$If!v h#v#v#v#v#vM#v C#v #v C#v L:V 94 , 55555M5 C5 5 C5 L/ / / / / /  / / / 44 9f4ytDkdq$$If94" K _(!$C'+MCCCCCL 44444 9af4ytD*stand16 =sum(ABOVE)#,##0.00D*Prem16 =sum(ABOVE)#,##0.00D*dollar16 =sum(ABOVE)#,##0.00D*motel16 =sum(ABOVE)#,##0.00D*nontax16 =sum(ABOVE)#,##0.00D*tax16 =SUM(ABOVE)#,##0.00D*oes16 =SUM(ABOVE)#,##0.00xDCOLTOT0$$If!v h#vU#vC#v#vC#v L:V 94 , 5U5C55C5 L/ 44 9f4yt~D* =sum(above)#,##0.00$$If!vh#v#vC#v#v#v#vL:V 94 ,55C5555L/ / /  / / 44 9f4yt~$$If!vh#v #v#v#v:V 945 555/ / / / / 44 9f4yt0B$$If!vh#v #v#v#v:V 945 555/ / / / / / /  44 9f4yt0Bt$$If!vh#v#vC:V 9455C/  44 9f4yt0B$$If!vh#v #v#v#v:V 945 555/ / / /  / 44 9f4yt0BvDMText13l$$If!vh#v+:V 94P,5+/ 44 9f4yt0B$$If!vh#v #v#v#v:V 945 555/ / /  / 44 9f4yt~$$If!vh#v+:V 94P  ,5+/  44 9f4p ytCtDeCheck9tDeCheck8tDeCheck7tDeCheck6$$If!vh#v#vh #v#v#v#v#v#v' :V 94 P,55h 555555' / / 44 9f4pPytC?kdؽ$$If94ִX Q Iu+h '  P    4 9af4pPytCf$$If!vh#v+:V 945+/ 44 9f4yt$$If!vh#v#v#v$#v)#v,#v:V 94555$5)5,5/ / / / 44 9f4yt$$If!vh#v#v#v$#v)#v,#v:V 94555$5)5,5/  44 9f4yttDeCheck5vDText31vD Text32jD jD DH Distribution10.00#,##0.00"$$If!v h#vU#vo#v#v$#v)#v3#v#v :V 94 , 5U5o55$5)5355 / / / / / / /  44 9f4yt$$If!vh#v#v#v$#v)#v3#v:V 94,555$5)535/  44 9f4yttDeCheck5vDText31jD jD jD DH Distribution20.00#,##0.00"$$If!v h#vU#vo#v#v$#v)#v3#v#v :V 94 , 5U5o55$5)5355 / / / / / / /  44 9f4yt$$If!vh#v#v#v$#v)#v3#v:V 94555$5)535/  44 9f4ytvDText31jD jD jD DH Distribution30.00#,##0.00($$If!v h#vU#vo#v#v$#v)#v3#v#v :V 94,,5U5o55$5)5355 / / /  / / /  /  44 9f4yt$$If!vh#v#v#v$#v)#v3#v:V 94,555$5)535/ /  44 9f4ytvDText31jD jD jD DH Distribution40.00#,##0.00($$If!v h#vU#vo#v#v$#v)#v3#v#v :V 94 ,,5U5o55$5)5355 / / /  / / /  /  44 9f4yt$$If!vh#v#v#v$#v)#v3#v:V 94+,555$5)535/ /  44 9f4ytvDText31jD jD jD DH Distribution50.00#,##0.00$$If!vh#v#v#v$#v)#v3#v#v:V 94 +,555$5)5355/ /  / / / 44 9f4yt$$If!vh#v#v#v$#v)#v3#v:V 94+,555$5)535/ /  44 9f4ytvDText31jD jD jD DH Distribution60.00#,##0.00 $$If!vh#v#v#v$#v)#v3#v#v:V 94 +,555$5)5355/ / / / / /  44 9f4yt2D* Text23V=(Distribution1+Distribution2+Distribution3+Distribution4+Distribution5+Distribution6)#,##0.00$$If!vh#v$#v#v:V 94 ,5$55/ / / / /  44 9f4ytW$$If!vh#v+:V $-5+44 $aytrkS$$If!vh#v+:V $5+44 $aytrky$$If!vh#v#v+:V Hh,55+/ 44 Haytrk^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH <`< NormalCJ_HmH sH tH d@d  Heading 1$ & F0@&^`05CJKHOJQJkHL@L  Heading 2$ & F@&5CJOJQJL@L  Heading 3$ & F@&5CJOJQJL@L  Heading 4$ & F@&5CJOJQJ>@>  Heading 5 <@&CJB@B  Heading 6 <@&6CJF@F  Heading 7 <@& CJOJQJJ@J  Heading 8 <@&6CJOJQJL @L  Heading 9 <@&56CJOJQJDA`D Default Paragraph FontVi@V  Table Normal :V 44 la (k (No List POP BLANKLINEdx5CJOJQJkHTOT Captions 6ptd(CJ OJQJkHDOD Captions 6pt bold5`O"` Captions 6pt boxd<5CJ OJQJkHD2D Captions 6pt Nbox<DOBD Captions 7pt dtCJDOARD Captions 7pt Bold5`Ob` Captions 7pt boxdt<5CJOJQJkH^Or^ Captions 7pt NBoxdt<CJOJQJkHPOP Captions 8pt d`CJOJQJkH^O^ Captions 8pt Bold d`5CJOJQJkHFF Captions 8pt box <DD Captions 8pt NboxPPOP Captions 9pt dLCJOJQJkHJOJ Captions 9pt BolddLCJFOF Captions 9pt Box PDOD Captions 9pt Nbox5TOT Captions 10pt d`(CJOJQJkHbOb Captions 10pt Bold!d`(5CJOJQJkH\O"\ Captions 10pt box"d`PCJOJQJkHHO2H Captions 10pt Nbox#P5HOBH Date 08pt $d8(CJOJQJkH6OAR6 Date 09pt%CJ6OAb6 Date 10pt&CJ2Oar2 Date 11pt'CJ8 @8 Footer ( !CJVOV Form Title 10pt)$d8a$CJOJQJkHbOb Form Title 10pt Bld*$d8a$5CJOJQJkHVOV Form Title 11pt+$d$a$CJOJQJkHLOL Form Title 11pt Bld,d$CJVOV Form Title 12pt-$da$CJOJQJkHbOb Form Title 12pt Bld.$da$5CJOJQJkHO Large Bulletp/ & F0>T^`0CJROR Letter Text 10pt0d$CJOJQJkHFOF Letter Text 11pt1dCJRO"R Letter Text 12pt2dCJOJQJkH2O22 Memo Body3CJB Numberp4 & F0>T.^`0.)@Q. Page NumberHObH Small Blank Line 6CJr Small Bulletp7 & F0>T^`0XOX User Input 10pt8d8(5OJQJkHTOT User Input 11pt9d$5CJOJQJkH\O\ User input 12pt:d((5CJOJQJkHRoR Address1;d8(OJQJ_HmH sH tH BOB Body text 1 <`5CJHP@!H Body Text 2=d`5CJBQ@1B Body Text 3 >`5CJNoN CareOf?d8(OJQJ_HmH sH tH VoV CaseNumber@d8(OJQJ_HmH sH tH VoV ClientCityAd8(OJQJ_HmH sH tH Xo"X ClientStateBd8(OJQJ_HmH sH tH To2T ClientZipCd8(OJQJ_HmH sH tH ToBT CoAddressDd8(OJQJ_HmH sH tH VoRV CoAreaCodeEd8(OJQJ_HmH sH tH NobN CoCityFd8(OJQJ_HmH sH tH XorX CoExtensionGd8(OJQJ_HmH sH tH \o\ CoPhoneNumberHd8(OJQJ_HmH sH tH PoP CoStateId8(OJQJ_HmH sH tH \o\ CoSuppaddressJd8(OJQJ_HmH sH tH o GranteeFirstName3K$ p@ P ^a$CJ_HmH sH tH VoV CountyNameLd8(OJQJ_HmH sH tH LoL CoZipMd8(OJQJ_HmH sH tH LoL Date1Nd8(OJQJ_HmH sH tH RoR DistrictOd8(OJQJ_HmH sH tH ToT FirstNamePd8(OJQJ_HmH sH tH VoV FirstName2Qd8(OJQJ_HmH sH tH `o"` GranteeLastNameRd8(OJQJ_HmH sH tH Ro2R LastNameSd8(OJQJ_HmH sH tH ToBT LastName2Td8(OJQJ_HmH sH tH PoRP OtherIDUd8(OJQJ_HmH sH tH PobP SectionVd8(OJQJ_HmH sH tH \or\ SuperAreaCodeWd8(OJQJ_HmH sH tH ^o^ SuperExtensionXd8(OJQJ_HmH sH tH bob SuperPhoneNumberYd8(OJQJ_HmH sH tH ^o^ SupervisorNameZd8(OJQJ_HmH sH tH JoJ Unit[d8(OJQJ_HmH sH tH NoN Worker\d8(OJQJ_HmH sH tH ^o^ WorkerAreaCode]d8(OJQJ_HmH sH tH `o` WorkerExtension^d8(OJQJ_HmH sH tH VoV WorkerName_d8(OJQJ_HmH sH tH XoX WorkerPhone`d8(OJQJ_HmH sH tH XoX CountyNumbera#CJ OJQJ_HmHnHsH tH uFO"F Numbers b$da$5B*CJOJQJ8O!28 Entries c$(a$CJ4!B4 LargeEntriesdHORH SITEHEAD e +5CJOJQJ<ob< - PAGE -f_HmH sH tH BorB Page X of Yg_HmH sH tH @o@ Created byh_HmH sH tH @o@ Created oni_HmH sH tH DoD Last printedj_HmH sH tH FoF Last saved byk_HmH sH tH <o< Filenamel_HmH sH tH NoN Filename and pathm_HmH sH tH ToT Author Page # Daten_HmH sH tH `o` Confidential Page # Dateo_HmH sH tH FOF Director p$<a$5CJ OJQJ&O& GovqCJ>O"> Co_info r 8 CJOJQJ@O2@ Co_info2 s^ CJ OJQJ*OB* SoMt5CJ8OR8 FIAu$a$5CJOJQJVobV Table Textv%B*CJOJQJ_HmH phsH tH r numberw$ & F p@ P 0>T.^`0a$ BulletSmx$ & F p@ P 0>T^`0a$ BulletLgy$ & F p@ P 0>T^`0a$O1 CC:z & F # p@ P >T@CC:`CJDTD Block Text{x]^2B2 Body Text|xPMP Body Text First Indent }`HCH Body Text Indent~hx^hTNT Body Text First Indent 2 `RRR Body Text Indent 2hdx^hPS@P Body Text Indent 3hx^hCJ6"@6 Caption xx52?22 Closing ^8@B8  Comment TextCJ$L@$ Date@Y@b@  Document Map-D OJQJ8+@r8  Endnote TextCJd$@d Envelope Address!@ &+D/^@ OJQJF%@F Envelope Return CJOJQJ:@:  Footnote TextCJ44 Header !: : Index 1^`: : Index 2^`: : Index 3^`: : Index 4^`:: Index 5^`:: Index 6^`:: Index 7^`:: Index 8^`:: Index 9p^p`B!@B  Index Heading 5OJQJ4/b 4 Listh^h`82r 8 List 2^`83 8 List 38^8`84 8 List 4^`85 8 List 5^`:0 : List Bullet & F>6 > List Bullet 2 & F>7 > List Bullet 3 & F>8 > List Bullet 4 & F>9 > List Bullet 5 & F BD B List Continuehx^hFE F List Continue 2x^FF" F List Continue 38x^8FG2 F List Continue 4x^FHB F List Continue 5x^:1R : List Number & F >:b > List Number 2 & F >;r > List Number 3 & F >< > List Number 4 & F >= > List Number 5 & Fh-` h  Macro Text"  ` @ OJQJ_HmH sH tH lI@ l Message Header.8$d%d&d'd-D^8`OJQJ> > Normal Indent ^4O4 Note Heading<Z@ < Plain Text CJOJQJ0K0 Salutation6@ 6 Signature ^BJ@ B Subtitle$<@&a$OJQJT,T Table of Authorities^`L#L Table of Figures ^` L>@B L Title$<@&a$5CJ KHOJQJB.@B  TOA Headingx 5OJQJ&& TOC 1.. TOC 2 ^.. TOC 3 ^.. TOC 4 ^.. TOC 5 ^.. TOC 6 ^.. TOC 7 ^.. TOC 8 ^.. TOC 9 ^O (BWBullet2)v$ & F>T8@..^`a$ CJOJQJH@ H 5 Balloon TextCJOJQJ^JaJNo N 5Balloon Text CharCJOJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] 5$P j 4t~p !l"#b$\%v&6'@(")@**+--./0124~57j9:;T<=* ,&(-15689:;=>?@BCDEGHIJLMNOPRSTUWXYZ[]^_`gjot|r  f 0 $r $H(,055J666(7779:::;;;;<<<=====~Z`l:l|&*, !"#$%')*+,./02347<AFKQV\abcdefhiklmnpqrsuvwxyz{ &(*68;GMO[aVbhjvy{'>N!,8=?KQS_egsy{ 157<?KPVbhjv|~"HLNSVbgo{ ).0;aeglo{     ) . 0 < A C N t x z      ! - 2 4 @ E G S X Z e    % ' 3 8 : F K M Y ^ ` l q s ~    % ' 3 8 : F K M Y ^ ` l q s       $ ) + 7 < > J O Q ] b d p u w  )/1=BDPUWchjv{}(.0<BDPUWchjv{}  $068DJLX^`lqs!&)5:BNTVbhjv|~9=?DGSXZflnz&QUW\_kpv "$057Bmqsx{ (-/;@BNSU`  %'2@DFKMXfjlqs~ #"7G[kIYfruw !')5;?KP&,.:@DPU&+;GJLX^`lrt %5FFFFFFFFFFFFFFFFFFG$G$G$G$FFFFFFFFFFFFFF"FFFFFFFFFFFF"TFFFFFFFFFFFF"FFFFFFFFFFFF"FFFFFFTFFFFFF"FFFFFFFFFFFF"FFFFFFFFFFFF"FFFFFFFFFFFF"FFFFFFFFFFFF"FFFFFFFFFFFF"FFFFFFFFFFFF"TFFFFFFFFFFFF"FFFFFFFFFFFF"FFFFFFFFFFFF"FFFFFFFFFFFF"F"F"F"F"F"F"F"FF"FG$G$G$G$G$FFFFFG$FFFFFFFFFFFFFFFFFFFFFFFFFF"JQS!t8@0(  B S  ?Text4Text6Text7Text8Text9Text10Text14Text15Text5Text33Text11Text12Text25Text26Text27Text28Text29Check1Check4Check3Check2Text13Text30Text16Text17Text18Text19stand1Prem1dollar1motel1nontax1tax1oes1daily1Text34stand2Prem2dollar2motel2nontax2tax2oes2daily2stand3Prem3dollar3motel3nontax3tax3oes3daily3stand4Prem4dollar4motel4nontax4tax4oes4daily4stand5Prem5dollar5motel5nontax5tax5oes5daily5stand6Prem6dollar6motel6nontax6tax6oes6daily6stand7Prem7dollar7motel7nontax7tax7oes7daily7stand8Prem8dollar8motel8nontax8tax8oes8daily8stand9Prem9dollar9motel9nontax9tax9oes9daily9stand10Prem10dollar10motel10nontax10tax10oes10daily10stand11Prem11dollar11motel11nontax11tax11oes11daily11stand12Prem12dollar12motel12nontax12tax12oes12daily12stand13Prem13dollar13motel13nontax13tax13oes13daily13stand14Prem14dollar14motel14nontax14tax14oes14daily14stand15Prem15dollar15motel15nontax15tax15oes15daily15stand16Prem16dollar16motel16nontax16tax16oes16COLTOTCheck9Check8Check7Check6Text31Text32 Distribution1 Distribution2 Distribution3 Distribution4 Distribution5 Distribution6Text23 +;OVj{?,?Sg{V 0  0 C  ! 4 G Z   ' : M ` s   ' : M ` s  + > Q d w 1DWj}DWj}`s~$7 /BU'Ms8\gw@E5  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~ )9Nbiz(O">Rfz=iT /m  / B 3 F Y  & 9 L _ r  & 9 L _ r * = P c v CVi|Vi| r'E]#6y.AT&Lr#HlvQV,&5,S]-S].S]p 5w 59*urn:schemas-microsoft-com:office:smarttagsState9*urn:schemas-microsoft-com:office:smarttagsplace ؾ ]4_4`4b4c4e4f4h4i445""y))},,K/d//0]4_4`4b4c4e4f4h4i44533333  )*9;NObVijz{",>?RSfgz{=iiT  /0mo   / 0 B C  ! 3 4 F G Y Z    & ' 9 : L M _ ` r s    & ' 9 : L M _ ` r s  * + = > P Q c d v w 1CDVWij|}/0CDVWij|} 77`rs'UU~EGYZmn]#$67y{{ ./ABTU&'LMrs$&&fvw()<?Q-.ADV,;KL_`st&((\4]4_4`4`444444444445  )*9;NObVijz{",,>?RRSfgz{=iiT  /0mo   / 0 B C  ! 3 4 F G Y Z    & ' 9 : L M _ ` r s    & ' 9 : L M _ ` r s  * + = > P Q c d v w 1CDVWij|}/0CDVWij|} 77`rs'UU~EGYZmmn]#$67y{{ ./ABTU&'LMrs$&&fvw()<?Q-.ADV,;KL_`st&((\4]4]4_4`4`4b4c4e4f4h4i44445|R}5~p: 0`HFDiϜn.r@(% 4' m,/ vJ/< o_3$+6((b^`.^`.88^8`.^`. ^`OJQJo( ^`OJQJo( 88^8`OJQJo( ^`OJQJo(hh^h`. hh^h`OJQJo(h^h`. hh^h`OJQJo( hh^h`OJQJo( hh^h`OJQJo(p0p^p`0.@ 0@ ^@ `0o(.0^`0.6vJ/ o_3~}|(%m,/4' @T]%R['&%R9+%R%R555 UT20Bj~u ? gOF$jt(b*-+[+S4D8@|: >o@@wBCEEEF-MUNcJT`4X`3dxdfgg`o1bp"kp[rs"rtOGw=&m5R_~DG`2m.)s| h+Y(fUu@wXxn`v]4_4@@{< 5             $ & ( * , . 0 2 4 6 p@ : < Unknown G* Times New Roman5Symbol3. * Arial9 Webdings?= * Courier New7Tms Rmn5. *aTahoma;WingdingsA$BCambria Math"hcu&+f jFD",_,_r c#24C4C4e33QHX?[+*!xx 7DHS-1582-TV-NSE, Travel Voucher For Non State EmployeesComp martinezlP            Oh+'0, @L l x  8DHS-1582-TV-NSE, Travel Voucher For Non State EmployeesComp1582-TV-NSE.dot martinezl68Microsoft Office Word@L{FL@V r@޶@`Y,՜.+,00 hp  State of Michigan_C4 8DHS-1582-TV-NSE, Travel Voucher For Non State Employees Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefgijklmnoqrstuvw|Root Entry FFz~Data 1TableoWordDocument8PSummaryInformation(hDocumentSummaryInformation8pCompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q