The mileage claim form is a State Board of Accounts approved form and they require that the original be submitted for payment; therefore copies or faxes will be returned to you in exchange for the original document. State Board of Accounts requires odometer readings between buildings, unless we have a Fixed Distance Mileage Chart. We publish a updated Mileage Chart periodically, upon completion of processing the claims submitted that month. 

1. Enter your name in top right comer
2. Enter the Year and specific Date of Travel
3. Enter Building you are traveling from in Column 2 and Building you are traveling to in Column 3.
4. Multiple destinations are not allowed in the TO column unless you are returning to your starting point.
5. Enter odometer readings in Column 4 titled "Odometer Reading"; if there is no distance identified on the Mileage Chart.
6. Enter Nature of Business in Column 5. (Examples: Therapy, Meeting, Testing, Case Conference, Workshop, etc.) This cannot be left blank.
7. Enter the miles you traveled in Column 6 titled (Auto Miles Traveled) (either from the mileage chart or from your odometer readings).
8. Date and Sign the form at the bottom. Without your signature we can not pay your claim.