Research Corporation of the University of Hawaiʻi

RESEARCH CORPORATION OF THE UNIVERSITY OF HAWAII
RELOCATION ALLOWANCE REQUEST
Campus:
Date: —,-‘-‘-
(MM/DD/YY) DOCUMENT NUMBER
D Partial Payment D Final Payment
APPOINTEEN’SAME(LasNtameF,irstNameM,iddleInitial) SOCIALSECURITNYUMBER DEPARTMENT
;”
ACCOUNT CODE …BUD{:AT OUNT
TOTAL $ APPOINTEE’STITLE APPOINTMENTDATE DATEDEPARTED DATEARRIVED
“”” ADDRESSFROMWHICHRELOCATED(StreetAddressC,ity,StateZ,ipCode)
ALLOWABLEIDEDUCTIBLE EXPENSES(Reportable/NonTaxable)
AIRFARE:
MILEAGE: LODGING:
Appointee (Spouse & Dependents)
miles X $ =B.U. rate AttachMileageForm
SHIPPING COST:
TAXI, PARKING FEES, etc.:
Personal Effects and Professional Materials
SUB TOTAL: ALLOWABLE EXPENSES
NONDEDUCTIBLE RELOCATION EXPENSES(Reportableffaxable) AttachSponsorApproval,maybesubjectto Federal,State,FICA, & Medicarewithholding
$
$ $
OTHERS:
SUB TOTAL: EXCEPTION EXPENSES TOTAL RELOCATION ALLOWANCE
SUBMITTEDBY: APPROVED BY:
–
1. COMPLETE PAYMENT DOCUMENT
2. OBTAIN REQUIRED SIGNATURES AND ATTACH APPLICABLE
INVOICES, RECEIPTS, ETC.
3. FORWARD TO YOUR FISCAL OFFICE
Form-17(02/01/03)
/ APPOINTEE DATE
PRINCIPAL INVESTIGATOR
/
, , DATE
/, FISCALOFFICER DATE
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