Payroll Moving Expense Reimbursement Form | Warner Pacific University

Must be submitted within 60 days of Hire Date

Approvals(Required)

HR Approval

Controller Approval

VP Operations

Name(Required)

First Middle Last

Position TItle(Required)

Date of Hire(Required)

Department(Required)

Division (if applicable)

Moving Information

Date of Move

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Former Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Purpose of Expense (Please submit a separate form per expense type)(Required)

Travel and Lodging for House-Hunting Trip (taxable)

Travel and Lodging for Move/ in Transit

Expenses/ Receipts (Complete appropriate categories and attach dated receipts reflecting payment made)

Airfare

Airfare Receipt(s)(Required)

Drop files here or

Max. file size: 100 MB.

Moving Company/ Van/ Trailer Rental

Moving Company/ Van/ Trailer Rental Receipt(s)(Required)

Drop files here or

Max. file size: 100 MB.

Lodging

Lodging Receipt(s)(Required)

Drop files here or

Max. file size: 100 MB.

Car Rental

Car Rental Receipt(s)(Required)

Drop files here or

Max. file size: 100 MB.

Postage/ Shipping

Postage/ Shipping Receipt(s)(Required)

Drop files here or

Max. file size: 100 MB.

Shipping Storage Pod

Shipping Storage Pod Receipt(s)(Required)

Drop files here or

Max. file size: 100 MB.

Supplies (e.g. tape, packing material)

Supply Receipt(s)(Required)

Drop files here or

Max. file size: 100 MB.

Tolls/ Fares/ Parking Fees

Toll/ Fare/ Parking Fee Receipt(s)(Required)

Drop files here or

Max. file size: 100 MB.

Gasoline OR Mileage (miles x IRS allowed moving rate)

Gasoline or Mileage Receipt(s)(Required)

Drop files here or

Max. file size: 100 MB.

Other*

Other Receipt(s)(Required)

Drop files here or

Max. file size: 100 MB.

Total

* For a definition of other allowed expenses, see IRS Publication 521, Moving Expenses. Moving expenses may not include food.

Phone

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