HomeMy WebLinkAboutOcr. R. Michael - Duty Related Injury - 8/31-10/11/2019 FINANCE DEPT. STAFF ONLY
LINE ITEM USED 010-11-1100-1345
TRAVEL REQUEST FY v, ;UBUDGETET) /6V U
CITY OF WATERLOO EXPENDED YTD
THIS REQUEST
LEFT AFTER THIS
REQUEST Z!�
DATE
Original-Clerk/Finance Co -Department
NAME(S) AND POSITION(S): DATE:
Officer Robert Michael October 11th, 2019
NAME OF CLASS I MEETING: DESTINATION: Iowa City, Iowa
Duty Related Injury DEPARTURE POINT
IF NOT WATERLOO:
DEPARTURE DATE: RETURN DATE: DATE(S) OF MEETING:
8/31/19 10/11/19 August 31-October 11th, 2019
PURPOSE OF TRAVEL:
Officer Michael was involved in a serious on duty injury on August 27th, 2019. The injury requires trips back and forth to
Iowa City(University of Iowa Clinics) for treatment. This will include mileage/fuel and parking only.
WILL TRAVEL REQUIRE ADDITIONAL PERSONNEL: x COST$ 00.00
YES NO
METHOD OF TRAVEL:
XXXXXXX CITY VEHICLE PRIVATE VEHICLE
AIRFARE DEPARTING FROM:
ESTIMATE OF COST: BUDGET LINE ITEM:
$00.00 LODGING 00.00 TAXI xx GRANT REIMBURSABLE
$00.00 MEALS PARKING YES NO
$00.00 REGISTRATION 490.00 AIRFARE xx REQUIRED CERTIFICATION
$646.13 MILEAGEIFUEL MISCITOLLS YES NO
TOTAL FOR ALL: $ 646.13 TOTAL: $ 646.13 PER PERSON
I BELIEVE THIS TRIP SERVES A PUBLIC PURPOSE I APPROVE THIS TRAVEL REQUEST
AND IS NE SARY AND BENEFICIAL TO THE
CITY OF WA RLOO
/
DEP �RTM HEAD MAYOR
D�, DATE