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TO:
Utah
State University
Controllers Office, Travel
Old Main, Room 26
2400 Old Main Hill
Logan, UT 84322-2400
I hereby
certify that due to the following circumstances I am requesting
payment be made to me from the attached photocopy of Travel
Authorization (TA) No. ____________.
Reason:__________________________________________________________
_________________________________________________________________
_________________________________________________________________
I also
certify that to this date I have not received payment (check
or otherwise) reimbursing me for travel expenses from the original
TA. In the event the original TA and/or a check issued to me
from the original TA come into my possession, I will return
them to the Controllers Office, Travel Department.
Traveler's
Signature: _______________________________________________
Printed
name: ____________________________________________________
Date:
_______________________________
