Fields marked with an * are required Name * Your Email * Charge to * Which committee or ministry group is supported by the expenses on this form? HTML Provide the name and mailing address of the reimbursement recipient below. Recipient Name Address * City * US States * - Select State - Virginia Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC Zip * Divider HTML EXPENSES Miles Mileage Calc Mileage (miles x 0.485) $ 0.00 Meals/Tips $ Postage $ Parking/Tolls $ Supplies $ Honoraria $ Lodging $ Grant $ Other $ Other Description HTML Total: $ 0.00 HTML DOCUMENTATION Please email copies of receipts and other documents to Temporary General Presbyter, Rev. Kerry Foster at tempgp@presbyteryofthejames.org. HTML Copy SIGNATUREType your name below. Your typed signature verifies the information is correct as submitted. Signature * If you are a human seeing this field, please leave it empty.
