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52/km OTHER EXPENSES Other Expense Details Net HST A Total Other Expenses Totals B TOTAL CLAIM A B Claimant Signature Ex. Expense Claim Form Date 20 Name STEM Site if applicable Address City KILOMETRES Date Trip Details From/To/Purpose of Travel KMs Total Kilometers Kilometrage Claim. Dir. Signature Approved Date Approved Note Please attach all receipts to the BACK of this Expense Report Account For Office Use Only Expense Breakdown Debit Cheque Number Date Paid Credit.
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