Fill and Sign the Finance Form Aaf 10 Rev

Finance Form AAF-10 (Rev. 02/04) STATE OF VERMONT AUTHORIZATION FOR OUT-OF-STATE TRAVEL AND/OR ADVANCE OF FUNDS AGENCY/DEPARTMENT: DATE: ESTIMATED COST: DEPART DATE: RETURN DATE: OUT-OF-STATE DESTINATION & REASON FOR TRIP: EMPLOYEE NUMBER: EMPLOYEE NAME: EMPLOYEE HOME ADDRESS: CHECK ROUTING FOR ADVANCE: POSITION TITLE: Mail check to home address Return check to department Check will be available two days after receipt of this request by the Treasurer's Office. Hold check for pickup Hold check and call This authorization to travel out-of-state is hereby approved and this department acknowledges its obligation to reimburse the State Treasurer for any default of payment by this employee of funds advanced for the purpose of this travel. APPROVED BY: SIGNED BY: SECRETARY OF ADMINISTRATION OR AUTHORIZED AGENT DEPARTMENT HEAD OR AUTHORIZED AGENT PROMISSORY NOTE THE PURPOSE OF A TRAVEL ADVANCE Employee No. received from the Vermont State Treasurer 20 At Montpelier, Vermont on I, as authorized by this request. I understand that this note is due and payable on or before the tenth day following my return from this trip and that this amount will be deducted an advance for travel in the Sum of $ from any reimbursement expenses paid after my return. If my reimbursement is not sufficient to cover the full amount of the advance, I agree to pay the difference. The State Treasurer will seek payment of any delinquent loan from me and from my department and will not grant any more advances until the delinquent loan is repaid. DATE: SIGNED EMPLOYEE SIGNATURE , , Social Security No.