Fifth Judicial District CASA Program

Volunteer Expense Voucher

This form is to be used by CASA volunteers to receive compensation for expenses incurred while performing official duties. Mileage will be compensated at the federally authorized rate.

CASE #. CASA Volunteer:

DATE	FROM	TO	ODOMETER BEGINNING	ODOMETER ENDING	TOTAL MILES	PURPOSE OF TRAVEL

TOTAL MILES ________________

Photocopies, Telephone, Postage & Other Expenses (Attach Receipts)

DATE	TYPE OF EXPENSE	AMOUNT

DATE SUBMITTED:

NAME OF CASA:

SIGNATURE OF CASA:

SOCIAL SECURITY #:

ADDRESS: