Expense Voucher for Jazz Performance Assessment Use this form to submit an expense voucher for the Jazz Performance Assessment event. I am a...(Required) JPA Adjudicator SCBDA Worker/Member I am seeking reimbursement for:(Required)Check all that apply. Mileage Other Expenditures Travel ExpensesAutomobile Travel FROM(Required) Automobile Travel TO(Required) Enter the number of ROUND TRIP miles.(Required)SCBDA Mileage Rate: .37 per mile. Round-trip mileage is capped at $50.00. Please complete the form with all the pertinent information, understanding that mileage will be capped at $50.00.HiddenMileage Rate(Required)Please enter a number from .37 to .37.Mileage Price(Required) Price: $0.00 Enter the number of ROUND TRIP miles.(Required)SCBDA Mileage Rate for JPA Adjudicators: .58 per mile.HiddenMileage Rate(Required)Please enter a number from .58 to .58.Mileage Price(Required) Price: $0.00 Mileage Cap Max Price: Other ExpensesAdditional Expenditure 1(Required)Enter a description of the expense. Amount 1(Required)Enter an amount for this expense. Additional Expense 1 Receipt(Required)Please upload a receipt for this expenditure.Accepted file types: jpg, png, tiff, pdf, Max. file size: 5 MB.Do you have any other eligible expenditures?(Required) Yes No Additional Expenditure 2(Required)Enter a description of the expense. Amount 2(Required)Enter an amount for this expense. Additional Expense 2 Receipt(Required)Please upload a receipt for this expenditure.Accepted file types: jpg, png, tiff, pdf, Max. file size: 5 MB.Do you have any other eligible expenditures?(Required) Yes No Additional Expenditure 3(Required)Enter a description of the expense. Amount 3(Required)Enter an amount for this expense. Additional Expense 3 Receipt(Required)Please upload a receipt for this expenditure.Accepted file types: jpg, png, tiff, pdf, Max. file size: 5 MB.Requester's InformationThe check should be made payable to:(Required) The check should be mailed to:(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email(Required)Please provide your e-mail address should we have a question during processing this voucher. Phone(Required)Please provide your phone number should we have a question during processing this voucher.TotalTotal Reimbursement Request