GENERAL FORM NO. 2 GENERAL FORM NO.

2
REVISED JANUARY 1992 REVISED JANUARY 1992

REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT

Date No. Date No.

RECEIVED from ___________________________ RECEIVED from ___________________________

(Name) (Name)

the amount the amount

of of
(Payments for subsistence, services, (Payments for subsistence, services,

rental or transportation should show ionclusive dates, rental or transportation should show ionclusive dates,

(purpose, distance,inclusive points of travel, etc) (purpose, distance,inclusive points of travel, etc)

PAYEE PAYEE

Name/Signature Name/Signature
Address Address
CTC Number CTC Number
Date of Issue Date of Issue
Place of Issue Place of Issue

WITNESS WITNESS

Name/Signature Name/Signature
Address Address
CTC Number CTC Number
Date of Issue Date of Issue
Place of Issue Place of Issue