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Expenditure Request / Reimbursement For Unit & Family Readiness … · 2016-08-04 · (Claimant fill out sections 1 through 7 only) NAVMC 11652 (Rev. 05-09) Expenditure Request

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Text of Expenditure Request / Reimbursement For Unit & Family Readiness … · 2016-08-04 · (Claimant...

  • (Claimant fill out sections 1 through 7 only)

    NAVMC 11652 (Rev. 05-09)

    Expenditure Request / Reimbursement For Unit & Family Readiness Funds

    3. C

    laim

    ant

    or P

    ayee

    Adobe Designer 8.0

    FOUO - Privacy Sensitive when filled in.

    FOR OFFICIAL USE ONLY.

    1. Unit 2. Date

    A - Volunteer Awards/Recognition (001)

    B - Volunteer Reimbursements (002)C - Light Refreshments (003)

    D - Unit Parties/Picnics (004)

    E - UFR Child Care (005)

    F - Direct/Overhead Exp - Comm (006)

    G - Direct/Overhead Exp - Travel (007)H - Direct/Overhead Exp - Other (008)

    I - MWR Support (009)

    J - Marine Corps Ball (010)

    Attach original receipts

    Line

    Tran

    sact

    ion

    Dat

    e

    Cod

    e

    (c) Item Description and Location of Purchase Amount Requested(b)(a)

    5. Expenditures

    (d) Mileage, Fares & Tolls

    (e) From (Beginning Location)

    (f) To (Ending Location) (g) Mileage

    (h) Mileage Times Mileage Rate ($) (i) Fare or

    Toll ($)

    (j) Total of Mileage (h) + Fare or Toll (i)

    a. Name (last, first, middle initial)

    b. Title (FRO, Volunteer, Vendor) c. Phone Number

    d. Mailing AddressCheck Advance

    Direct Deposit Credit Card

    Petty Cash U&FRF

    Req & Issue Other

    4. Payment Method

    1

    2

    3

    4

    5

    6

    7

    8

    9

    10

    11

    12

    13

    14

    15

    Expendatures Subtotal

    6. Amount of Request / Reimbursement (total of column)

    $0.53

    Accounting Classification (Office Use Only)12. Voucher Number 13. Cost Center 14. Tracking Number

    11. Reconciliation of Advance Payments

    a. Beginning Balance b. Amount Disbursed c. Receipts Attached Total d. Cash Collection Receipt e. Due to Payee

    Disbursement processed by : Voucher # : Date :

    8. This request / claim approved (FRO / Commander Designee)

    9. This claim is certified correct and proper for payment (UFRFA / CFO).

    7. I certify that this request / claim is true and correct to the best of my knowledge that payment or credit has not been received by me.

    10. Cash Payment Receipt

    b. Date

    a. Payee

    c. Amount

    Approving Official

    Authorized Certifying Official

    DateDateClaimant

    Sign HereName

    Sign

    Date

    Name

    Sign

    Name

    Sign

    Mileage Subtotal

    Total

    (Claimant fill out sections 1 through 7 only)

    NAVMC 11652(Rev. 05-09)

    Expenditure Request / Reimbursement For Unit & Family Readiness Funds

    3. Claimant

    or Payee

    Adobe Designer 8.0

    FOUO - Privacy Sensitive when filled in.

    FOR OFFICIAL USE ONLY.

    1. Unit

    2. Date

    A - Volunteer Awards/Recognition (001)

    B - Volunteer Reimbursements (002)

    C - Light Refreshments (003)

    D - Unit Parties/Picnics (004)

    E - UFR Child Care (005)

    F - Direct/Overhead Exp - Comm (006)

    G -Direct/Overhead Exp - Travel (007)

    H -Direct/Overhead Exp - Other (008)

    I - MWR Support (009)

    J - Marine Corps Ball (010)

    Attach original receipts

    Line

    Transaction

    Date

    Code

    (c) Item Description and Location of Purchase

    Amount Requested

    (b)

    (a)

    5. Expenditures

    (d) Mileage, Fares & Tolls

    (e) From

    (Beginning Location)

    (f) To

    (Ending Location)

    (g) Mileage

    (h) Mileage Times

    Mileage Rate ($)

    (i) Fare

    or

    Toll ($)

    (j) Total of

    Mileage (h) +

    Fare or Toll (i)

    a. Name (last, first, middle initial)

    b. Title (FRO, Volunteer, Vendor)

    c. Phone Number

    d. Mailing Address

    Check

    Advance

    Direct Deposit

    Credit Card

    Petty Cash

    U&FRF

    Req & Issue

    Other

    4. Payment Method

    1

    2

    3

    4

    5

    6

    7

    8

    9

    10

    11

    12

    13

    14

    15

    Expendatures Subtotal

    6. Amount of Request / Reimbursement (total of column)

    $0.53

    Accounting Classification (Office Use Only)

    12. Voucher Number

    13. Cost Center

    14. Tracking Number

    11. Reconciliation of Advance Payments

    a. Beginning Balance

    b. Amount Disbursed

    c. Receipts Attached Total

    d. Cash Collection Receipt

    e. Due to Payee

    Disbursement processed by :

    Voucher # :

    Date :

    8. This request / claim approved (FRO / Commander Designee)

    9. This claim is certified correct and proper for payment (UFRFA / CFO).

    7. I certify that this request / claim is true and correct to the best of my knowledge that

    payment or credit has not been received by me.

    10. Cash Payment Receipt

    b. Date

    a. Payee

    c. Amount

    Approving

    Official

    Authorized

    Certifying

    Official

    Date

    Date

    Claimant

    Sign Here

    Name

    Sign

    Date

    Name

    Sign

    Name

    Sign

    Mileage Subtotal

    Total

    8.0.1291.1.339988.308172

    Print: Reset: Date: Unit: PhoneNumber: Name: Title: MailingAddress: check: 0advance: 0DirectDeposit: 0CreditCard: 0PettyCash: 0UandFRF: 0ReqIssue: 0Other: 0Item1: Item2: Item3: Item4: Item5: Item6: Item7: Item8: Item9: Item10: TransDate1: TransDate10: TransDate9: TransDate8: TransDate7: TransDate6: TransDate5: TransDate4: TransDate3: TransDate2: Code1: Code10: Code9: Code8: Code7: Code6: Code5: Code4: Code3: Code2: AmountReq1: ExpendatureSubtotal: AmountReq10: AmountReq9: AmountReq8: AmountReq7: AmountReq6: AmountReq5: AmountReq4: AmountReq3: AmountReq2: e11: e12: e13: e14: e15: TransDate11: TransDate15: TransDate14: TransDate13: TransDate12: j11: j15: j14: j13: j12: ReimbusementTotal: MilageSubtotal: i11: i15: i14: i13: i12: f11: f12: f13: f14: f15: h11: h15: h14: h13: h12: g11: VoucherNumber: CostCenter: TrackingNumber: BeginBal: AmountDisb: RecAttTot: CashCollecRec: DueToPayee: Date11: VouchNum: DisbProcBy: Date7: ClaimantSignature: ApprOfficialSignature: Date8: ApprOfficialName: AuthCertSignature: Date9: AuthCertName: Amount10c: PayeeSignature: Date10: PayeeName: