Date of Expense:

Expense Purpose:

Submitted By:

Signature:

Expenses

Printing, Folding, Collating, Etc.:

$

Bulk Mail Permit Renewal:

$

Bulk Mail Application:

$

Misc. Postage:

$

Misc. Meals:

$

Lodging:

$

Travel:

$

Other Expenses (Explain):

$

$

$

$

$

$

Total Reimbursement Requested:

$

Make Check Payable To:

Ohio Section AWWA Use Only:

APV No:

Date Paid: