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New Mexico Judicial Education Center All Travel advances will be paid @ 100% reimbursement rate. It is very important that the information below is filled out correctly for proper payment. Name: _______________________________________ Social Security #___________ Business Address:________________________________________________________ City:________________________________ State:___________ Zip:______________ Work Phone:________________________ Email:_____________________________
Purpose of Trip:______________________________________________________________________ Origin: ______________________________ Destination:____________________________________ What date and time would you DEPART? What date and time would you RETURN? Date:___________ Time:______________ Date:_____________ Time:___________ Þ Are you driving home everyday? Yes No Þ Are you driving your own personal vehicle? Yes No **NOTE: You cannot claim mileage on State vehicles. Trip Mileage? Official Map Mileage Will Be Used NOTE: Upon completion of your travel, you MUST complete the Judicial Education Center Mileage/Per Diem Reimbursement form for any changes that may have occurred after receiving your advance payment from the Judicial Education Center. Any amounts that are owed or overpaid to you will be resolved at that time. ____________________________________________________________________________________ I HEREBY CERTIFY THE FACTS STATED ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.
Date: ______________________ ___________________________________ Signature of Recipient Date: ______________________ ___________________________________ JEC Representative Return this form to: * Tel: (505) 277-5006 * Fax: (505) 277-7064 |