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Reimbursement for Personally-Owned Vehicle Use (DA MV7)
State of Louisiana, Division of Administration Form Required for Reimbursement for Mileage When Using Personally-Owned Vehicle for Official College Business
Handle: Document-311
Owner: Laiche, Karen (User-23, klaich:DocuShare)DS
Monday, March 31, 2003 10:56:51 AM CST
Monday, March 31, 2003 12:28:17 PM CST
Modified By: Laiche, Karen (User-23, klaich:DocuShare)DS
Locked By:
  • DA 5215 (DA MV 7) STATE OF LOUISIANA REIMBURSEMENT FOR PERSONALLY-OWNED VEHICLE USE PERIOD COVERED: (complete one) MONTH YEAR OR FISCAL YEAR -- 3 5 6 4 1 3 0 5 41 Agency Number DELGADO COMMUNITY COLLEGE Agency Name Total Miles (Round off to nearest mile) FISCAL YEAR REPORT ONLY: Number of Employees at or For fiscal year report only, identify on a separate above annual breakeven mileage page individual employees at or above breakeven mileage and mileage for which reimbursement was paid to each.
  • Number of employees below annual breakeven mileage Signed: ______________________________________________ Title: Phone: Date: ______________________________________________ DIVISION OF ADMINISTRATION
Microsoft Office Word (.doc, .dot) - application/msword
Appears In: ALL FORMS - Alphabetically Listed by Form Title DELGADO FORMS
Preferred Version: Reimbursement for Personally-Owned Vehicle Use (DA MV7)