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[null,null,"SEIU Local 1000"]
[null,null,"1808 - 14th Street, Sacramento, CA  95814"]
[{"$nulls":12},"Accounting Use Only"]
[]
[]
["Name (print)",{"$nulls":4},"Phone Number",{"$nulls":3},"Date"]
[]
["Mailing Address",{"$nulls":5},"City",null,null,"Zip Code"]
[]
["E-Mail Address"]
[]
[]
["Date"]
["Location"]
["Time Depart"]
["Time Return"]
["Activity"]
[]
["Activity Code"]
[]
[null,null,"LODGING",null,"LODGING",null,"LODGING",null,"LODGING",null,"LODGING"]
["1.   Room"]
["2.   Incidentals"]
[null,null,"MEALS",null,"MEALS",null,"MEALS",null,"MEALS",null,"MEALS"]
["3.   Breakfast"]
["4.   Lunch"]
["5.   Dinner",{"$nulls":11},"I hereby certify that this is a true statement of travel expenses incurred by me in accordance with the current travel expense policy of Local 1000 during the period of this claim, that all items shown were for official business of Local 1000, and that no expenses herein were received from or paid by any other source."]
[null,null,"TRAVEL",null,"TRAVEL",null,"TRAVEL",null,"TRAVEL",null,"TRAVEL"]
["6.   Common Carrier"]
["7.   Airporter"]
["8.   Personal Car"]
["9.   Parking"]
["10. Bridge Tolls"]
[null,null,"MISCELLANEOUS",null,"MISCELLANEOUS",null,"MISCELLANEOUS",null,"MISCELLANEOUS",null,"MISCELLANEOUS",null,"Signature"]
["11. Taxi Cabs"]
["12. Telephone",{"$nulls":11},"Title"]
["13. Other (explain)",{"$nulls":11},"Total expense this page",{"v":0,"d":"$0.00"}]
["TOTAL",null,0,null,0,null,0,null,0,null,0,null,"Total attached pages"]
["Date","Item #","Comment",{"$nulls":9},"Grand total expenses",{"v":0,"d":"$0.00"}]
[{"$nulls":12},"Less - Travel advances"]
[{"$nulls":12},"Balance due to Member",""]
[{"$nulls":12},"Balance due to SEIU",{"v":0,"d":"$0.00"}]
[{"$nulls":12},"APPROVED"]
[]
[]
["SEIU Local 1000  /  Rev. 10/2009)                                                                  NOTE: 1 copy is sufficient.  Do not submit in triplicate."]
["Send claims to the address above, care of Accounting.              If there is a \"Balance Due to SEIU\", attach a check made out to SEIU Local 1000."]