MOVING EXPENSES SUPPORT FORM EXHIBIT

Form Instructions

1. Enter name of the individual requesting reimbursement
2. Enter the Penn State University ID number
3. Enter the "moving from" location including City, State/Country
4. Enter the "moving to" location including City, State/Country
5. Enter Total amount paid by you for the transportation of Household Good and Personal Effects
6. Enter Total amount paid by you to 3rd party (i.e., moving company, truck rental) for the transportation of Household Good and Personal Effects
7. Check Box must be checked if move is less than 50 miles further than current commute
8. Select the departure date, from the calendar, for move from old location to new location
9. Select the arrival date, from the calendar, for move from old location to new location
10. Enter the number of nights lodging for move from old location to new location
11. Enter the total dollar amount spent for lodging during move from old location to new location
12. Enter the total number of miles accumulated on your personal vehicle during move from old location to new location
13. This is a calculated field. No entry necessary
14. Enter the total dollar amount spent on meals, up to the per diem limit for the location, during move from old location to new location
15. Enter the total amount spent on other forms of transportation during move from old location to new location
16. Please specify Other forms of transportation (i.e., air, car rental, etc.)
17. Select the beginning date for storage of household and personal effects
18. Select the ending date for storage of household and personal effects (not to exceed 30 days)
19. Enter the total amount spent on storage
20. Select the beginning date of temporary housing
21. Select the ending date of temporary housing (not to exceed 30 days)
22. Enter the total amount spent on temporary housing
23. Add any additional notes, as needed
24. This is a calculated field. No entry necessary
25. This is a calculated field. No entry necessary
26. The individual requesting reimbursement must provide either a hand-written signature or provide their digital ID
27. If an hand-written signature is provided, enter the date the form was signed. If a digital ID provided, skip this field

Receipts are required for all reimbursed expenses except meals (up to the per diem limit for the location) and personal mileage.