Itinerant Clergy Moving Expense Requisition Please review the entire policy with special attention to ¶IV.B.6 regarding what are considered reimbursable expenses. *** Reminder – you are required to complete the So Your Moving Checklist prior to submitting this form. *** Itinerant Clergy Moving Expense Requisition 2019 You must complete this requisition in order to receive reimbursement for qualified moving expenses. You will receive a copy of this requisition, via email, once you submit it electronically. Please save the email as confirmation of your submission. You will need to attach your moving receipts (either in a jpeg or pdf format) to this report so the District Office can substantiate the expenses. Once all expenses have been verified, the District Office will forward the completed report, with appropriate receipts, to the Conference Treasurer for payment. This form must be received in the Treasurer's Office (not submitted) no later than four months following the date of the move. Reimbursements are not allowed to be made after four months. Sending District*BeaconCapitalCorridorFairwayGatewayHarborHeritageSoundNOT within the North Carolina ConferenceIf your above answer was NOT within the North Carolina Conference, where are you coming from?Date of Move* Date Format: MM slash DD slash YYYY Name* First Last Email* Enter Email Confirm Email Moving From:Church/Charge*Church/Charge Mailing Address*(Address of the church you are moving from.) 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City of Church/Charge*Pastor's NEW Mailing Address*We will be mailing your check to this address. Please make sure that we have any special information (ie: P.O. Box) so that you receive your check. Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How far was the move?*What type of appointment are you going to?*Full TimeStudentRetiringPlease review the entire policy with special attention to ¶IV.B.6 regarding what are considered reimbursable expenses. Itinerant Clergy Policy as of June 2019 (Contingent on Annual Conference approval)Amount Paid to Moving Company & out of pocketNO food or personal items.Lodging expenses while en routeNo food. MileageMultiply total mileage x 20 cents (per car from appointment to appointment) OR enter actual out of pocket expense for gas, oil, insurance, etc.Subtotal(This field will calculate your entries above and self-populate.)Advance ReceivedTotal Reimbursement RequestedReimbursement Total DueIf this total is a negative number (meaning the advance you received exceeded what you spent), will you be sending the difference to the Conference Treasurer's Office? Please note, if you don't send the Treasurer's Office the overage, the entire amount received as an advance will be reported as income on your 1099. If you send in the overage, only the total amount substantiated by receipts, for actual moving expenses will be reported as income on your 1099.YesNoPlease upload your documentation (receipts, invoices, etc.) here.If need assistance uploading your paperwork (in jpeg or pdf format), please call the District Office at 919.779.9435. WE ASK THAT YOU INCLUDE AN ITEMIZED LIST OF ALL YOUR EXPENSES ALONG WITH YOUR RECEIPTS. IF THIS IS NOT INCLUDED, YOUR REIMBURSEMENT COULD BE DELAYED. An example of the itemized form can be seen here. Fill-in-able templete for itemized form. Drop files here or Accepted file types: jpg, pdf. Completed by :*Please type out your full name. Email of person completing the form.* Enter Email Confirm Email CommentsThis field is for validation purposes and should be left unchanged.