Download printable Reimbursement Form here.

 

Payee’s Name:

BEHS Title/Capacity:

Date:

Payee’s Mailing Address:

Description of Expenses:

Date of Expense:

Reason (include case/seizure description, etc.)*

Approving Officer** Foster Horse:
Name No.

Amount:

**If this was an emergency, please indicate here with the date and officer’s initials: _____________________________________

Mileage Expenses:

Date of Expense:

Reason for travel (trailering, inspection, investigation, etc. Include case/seizure description, etc.):

Total Mileage:

IRS rate:

Amount:
X 0.35
X 0.35
X 0.35
X 0.35
X 0.35

I certify that these expenses were incurred in accordance with BEHS policies.

Member’s Signature: ____________________________________________________

Date: ________________

*All expenses must be accompanied by a receipt. You will not be reimbursed if a receipt is not provided—no exceptions except for mileage.

* All expenses must be pre-approved (for emergency expenses, please follow policy procedures

 

FOR INTERNAL USE ONLY:

Signature of Treasurer: _____________________________________

Check # __________

Dated: __________________

Amount: __________________

REIMBURSEMENT FORM INSTRUCTIONS

The following instructions are meant to provide step-by-step guidance in completing the Reimbursement Form.

1. Payee’s Name: Name of the person to be paid

2. Title/Capacity: State payee’s title (e.g., “member”, “volunteer”, “foster home”, “regional rep.”, etc.)

3. Date: Date that you are sending the form in for reimbursement.

4. Payee’s Mailing Address: Street/P.O. Box, City, State, Zip: Address where you want to receive payment.

5. Description of Expenses:
a. Date of Expense: Date the expense is incurred.
b. Reason for Expense: Purpose of expense (e.g., vet bill, film developing, postage, etc.) Please be as descriptive as possible in the allotted space and include case/seizure description, if applicable.
c. Approving Officer: Pre-approval is required for ALL expenses. If this is an emergency expense, please follow policy guidelines.
d. Foster Horse Name: Enter the BEHS name.
e. Foster Horse Number: Enter the BEHS number.
f. Amount: Total amount of expense.

6. Mileage Expenses:
a. Date of Expense: Date of travel.
b. Reason for Travel: Purpose of the trip (included destination and “investigation”, “pre-adoption inspection”, “seizure”, etc)
c. Total Mileage (x 0.14): Enter your roundtrip mileage here.
d. Amount: Use of your automobile will be reimbursed at the effective IRS rate posted. Enter the miles traveled multiplied by the posted rate here.

7. Total Expenses: Add up all expenditures and total here. This is the total amount of your reimbursement.

8. Member’s Signature: PLEASE sign your reimbursement form. All unsigned forms will be returned for signatures.

• All expenses MUST be pre-approved by a BEHS Officer and the Officer’s approval e-mail must be submitted for reimbursement. In the case of an emergency, verbal approval is acceptable but must be indicated on your form with the date and the officer’s initials.

• All reimbursements MUST be submitted within 60 days of the date incurred. This should allow ample time to receive vet bills, etc. If you find that you cannot submit a reimbursement form within these time limits, please notify the Treasurer immediately so that he/she may work with you.

• A receipt MUST accompany all expenses for IRS audit purposes including fuel expenses. Actual mileage reimbursement is the ONLY exception to this rule.

• Should you have any questions regarding the Reimbursement Form, please contact the Treasurer for further explanation.