GLOBAL MINISTRIES
Northern Illinois Synod
Evangelical Lutheran Church in America
103 W. State St., Rockford, IL 61101-1105
(815) 964-9934
Name: ______
Address:______
______
(City)(State)(Zip)
Auto Miles ____ at 53.5¢ per mile:$______
Tolls or Parking Fees:$______
Meals or Food:$______
Lodging:$______
Other (must specify)______:$______
Total Expenses:$______
Reimburse for above, or
Approve and return form to verify deductible contribution
- (Please note: If using this voucher as verification of an income tax deduction, per the IRS you may claim only 14¢ per mile as a charitable contribution. Therefore, change the 53.5¢ figure above to 14¢ per mile before calculating your expense.)
NOTE: Per IRS Publication 463, all reimbursements must include “an adequate accounting of expenses, (i.e. receipts and records of mileage) and must be submitted within 60 days of the expense(s) occurring.” Also, should an individual be audited, s/he must be able to provide documentation of mileage.
Date / Beginning / Ending / Business / PersonalMileage / Mileage / Miles / Miles
______
(Sub-Committee or Task Force)(Place of meeting)(Date)
I certify the above to be true and correct ______
(Signature of Individual Payee)
______
(Signature of Committee Chair)
Global Ministries / Tanzania__ 080-58110 / GM - Meetings/Events/Mileage / __ 080-58310 / GM - ELCT, Arusha Diocese Support
__ 080-58120 / GM - Meetings/Food / __ 080-58330 / GM - ELCT, Seminary Scholarships
__ 080-58140 / GM - Postage/ Printing/Cards / __ 080-58331 / GM - ELCT, High School Scholarships
__ 080-58230 / GM - ELCA Workshops / __ 080-58332 / GM - ELCT, Evangelist Scholarships
__ 080-58240 / GM - ELCA Missionaries / __ 080-58350 / GM - ELCT, Companion Congregations
Mwangaza / Arusha
__ 080-58260 / GM - Mwangaza Annual Support / __ 080-58410 / GM - ALC, General Expense
__ 080-58290 / GM - Mwangaza Teacher/Staff Visits / __ 080-58480 / GM - ALC, Schools
__ 080-58490 / GM - ALC, Visitors