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    2022-2023 form (updated July 1st with new rate)

    This form is a downloadable spreadsheet.  Click here to download the form.

    • Download and save the form to your device.
    • Fill one form out for each month you are claiming reimbursement for.
    • Mileage for any given day should be on the line for which the day of the month corresponds with the number on the left-hand side of the sheet. For example, travel on January 10th should be on the line with the number 10 on the left-hand side.
    • After you print the form out, you will see a place to put the month in the top left corner.
    • All forms must be signed by you and then by your supervisor.  (Digital signatures are not accepted.)
    • This is a one-page document, so please print it on one page, portrait.   
    • Please, DO NOT ALTER this form.
    • Please have your Supervisor sign it, and then send it to the county office.
    • Submit your forms monthly.