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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Moving Expense Reimbursement Form"]
[]
[]
[]
[null,"The amount reimbursed for moving expenses will show up on your W-2 form at the end of the year. Since the total moving expense is not reimbursed, duplicate receipts should be retained for Income Tax Purposes."]
[]
[]
[null,"GENERAL GUIDELINES"]
[null,"• Request for reimbursement must have itemized statements and supporting invoices attached."]
[null,"• Itemized statements and invoices must indicate that they have been paid in full"]
[null,"• Reimbursement is limited to the moving of household items & is generally limited to one household"]
[null,"• Reimbursement is not permitted for payment of storage, redelivery of household items, personal traveling"]
[null,null,"expenses, or pick-up/drop-off at more than one location."]
[]
[null,"Employment Category:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Faculty",null,null,null,null,null,null,null,null,null,"SPS",null,null,null,null,null,null,null,"Other:"]
[]
[null,"Employee ID:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Effective Date:"]
[]
[null,"Name: (Last, First)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Department:"]
[null,"New residence street/P.O. box:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"City:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Zip:"]
[null,"Name & address of previous employer:"]
[null,"Street / P.O. Box:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"City:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Zip:"]
[]
[null,"ITEMIZATION OF EXPENSES"]
[null,"Date",null,null,null,null,null,null,null,null,null,null,null,null,"Item",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Cost"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"TO BE COMPLETED BY DEPARTMENT CHAIR OR DEPARTMENT HEAD"]
[]
[null,"TOTAL Moving Expense",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(BL28:BV32)","v":0}]
[null,"Total Moving Reimbursement",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF((AV36)>4000,4000,AV36)","v":0}]
[]
[]
[null,"Department Chair or Head",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Division Head or Dean",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date"]
[]
[null,"DEPARTMENT COMMENTS"]
[]
[]
[]
[]
["The social security number is required for the furtherance of operations and business of the University which includes but is not limited to the provision of proper identification. "]

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