Moving
Expenses/Reimbursement Form
Campus address: ___________________________________Date: ____________________________
Allowance for moving expenses
_________________
1. List expenses for transportation and storage
of household goods and personal effects:
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Item description |
Amount |
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2. List
expenses for travel and lodging payments for moving from old to new
home. Do not include meals.
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Item # |
Item description |
Amount |
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3. List all other expenses such as food, rental
services, house search etc.
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Item # |
Item description |
Amount |
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Any expenses in #1 or #2 are tax exempt. Any
expenses in #3 are taxable. All
reimbursements will appear on your payroll check.
You can be reimbursed for gas expense or mileage at the rate of
.19 cents per mile, but not both.
Reimbursement can only be issued for receipted items. Please number receipts and attach.
Distance test - Your new workplace must be at least 50 miles farther
from your old home than your old workplace was.
Time test - If you are an employee, you must work full time in the
general area of your new workplace for at least 39 weeks during the 12 months
right after you move.
Please refer to IRS Publication 521 Moving Expenses which explains the
deductibility of certain expenses. The
link for this is http://www.irs.gov/pub/irs-pdf/p521.pdf
Please forward with approval to Payroll (Extension 6539).
(Immediate Supervisor)
(Additional space for recording items appears on next page.)
1. List expenses for transportation and storage
of household goods and personal effects (continued):
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Item # |
Item description |
Amount |
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2. List
expenses for travel and lodging payments for moving from old to new
home. Do not include meals (continued).
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Item # |
Item description |
Amount |
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3. List all other expenses such as food, rental
search, house search etc. (continued).
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Item # |
Item description |
Amount |
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