EXPENSE ACCOUNT STATEMENT






Employee:_________________________________________________________
For period ending:________________________________________________




                    REIMBURSABLE EXPENSES INCURRED


Hotel/Lodging $_________________________
Meals $_________________________
Tax $_________________________
Travel [air, train, bus] $_________________________
Personal auto _____ miles x ___ cents $_________________________
Parking $_________________________
Phone $_________________________
Other [itemize]:
                _____________________ $_________________________
                _____________________ $_________________________
                _____________________ $_________________________
                _____________________ $_________________________
Total: $_________________________
-------------------------


     I certify the above is a true statement of incurred
expenses in accordance with company policy.  Receipts are
attached.




_______________________________
                                               Employee




Approved for payment:




By:_____________________________