DMCJA

Request for Reimbursement of Expenses

Purpose of Expenditure: q Meeting q Other Date  
 

THIS FORM IS TO BE USED ONLY FOR EXPENSES NOT REIMBURSED FROM OTHER SOURCES
 
 
 
Date of Meeting: _____/_____/_____

Month Day Year

Location of Meeting: 

Name of Committee: 

Other (Explain): 

Mail to:
  • If a committee member, mail to the committee chair.
  • If other, mail to:

Judge Stephen Brown  
Grays Harbor County District Court  
102 W Broadway, RM 202A  
Montesano, WA  98563-3621

RECEIPTS FOR PAID EXPENSES MUST ACCOMPANY THIS VOUCHER.

Do not include expenses incurred by non-judicial spouse, or child or guest.

 
Item and Description Amount
I. COMMITTEE MEETING EXPENSES

Transportation

Airfare (coach) (1)

 
 
$
Ground To and From Terminals (taxi, limousine, etc.) (2) $
Auto:  Miles_____ at $.485 = $_____ Parking = $____ Toll = $_____ (3) $
Other (rental car, etc.):

Explain: 

(4)

 
 
$
Lodging, meals, gratuities and incidentals: 
 
 
 

TOTAL COMMITTEE/MEETING EXPENSES (Total Lines 1-5) (5)

 
 
 
 
$
II. NON-COMMITTEE/MEETING EXPENSES (telephone, postage, etc.)

Explain: 

(6)

 
 
$
TOTAL REIMBURSEMENT REQUESTED (Total Lines 5 & 6) $
Make Reimbursement Check Payable to:

Name: 

Address: 

Signature: 

FOR OFFICE USE ONLY

Committee Chair Approval:  Amount $__________

Signature:________________________________

Treasurer’s Action:  Amount Paid $____________

Check #:____________ Date:________________

Signature:________________________________

 
 

DISTRICT AND MUNICIPAL COURT JUDGES’ ASSOCIATION

MEAL AND MILEAGE REIMBURSEMENT RATES 
 

Private Vehicle Mileage Reimbursement Rate $ .485/Mile

Non High Costs Selected High Cost

Meal Areas Areas

Designated High Cost Locations in Washington State 
 

The lodging rate for all non high costs locations remains at $70/night.  The following locations in Washington State have been designated high cost for lodging and/or meals: 
 

KEY CITY COUNTY MAX. LODGING SUBSISTENCE MAX. PER DIEM
Anacortes/

Mt. Vernon**

Skagit $94 (June 1-Aug 31)

$80 (Sept 1-May 31)

$59 $153 (June 1-Aug 31)

$139 (Sept 1-May 31)

Bremerton Kitsap $79 $59 $138
Coupeville/Friday Harbor/Oak Harbor** San Juan $94 (June 1-Aug 31)

$80 (Sept 1-May 31)

$59 $153 (June 1-Aug 31)

$139 (Sept 1-May 31)

Everett/Lynnwood Snohomish $90 $54 $144
Kelso Cowlitz $110 $49 $159
Ocean Shores** Grays Harbor $112 (June 1-Aug 31)

$88 (Sept 1-May 31)

$44 $156 (June 1-Aug 31)

$132 (Sept 1-May 31)

Olympia/Tumwater/

Lacey

Thurston $80 $49 $129
Port Angeles** Clallam $126 (July 1-Aug 31)

$88 (Sept 1-June 30)

$59 $185 (July 1-Aug 31)

$147 (Sept 1-June 30)

Port Townsend** Jefferson $126 (July 1-Aug 31)

$88 (Sept 1-June 30)

$59 $185 (July 1-Aug 31)

$147 (Sept 1-June 30)

Seattle King $152 $64 $216
Spokane Spokane $77 $49 $126
Stevenson Skamania $110 $49 $159
Tacoma Pierce $108 $59 $167
Vancouver Clark $110 $49 $159
All Other Counties   $70 $39 $109
 
 

**SEASONAL RATES 
 
 

Rev. 10/2/07

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