ࡱ> ?A> $bjbjAA 4(#y#yppppp4pt/t[<, ]p "/ pp9*    pp   70&Pj@0p ,T! T!7 p7T pT! 6:   REQUEST FOR PARTIAL REIMBURSEMENT OF MOVING EXPENSES Eastern Illinois University, Charleston, Illinois  New full-time faculty and administrative and professional employees who move to Coles County from outside the commuting area (50 miles) may be reimbursed for expenses incurred in the actual moving of household goods and personal effects, as follows: 70% of actual cost or $5000 whichever is less, based on receipts.* * The University does not reimburse for food, passenger airline tickets, private auto mileage, motel expense or for house-hunting trips. When you have moved to Coles County, please complete and return this form. The check will be processed by our Business Office and mailed to the address below. Please print or type.  FORMTEXT        FORMTEXT       Name of Employee Social Security Number  FORMTEXT        FORMTEXT       Local Mailing Address Home Telephone Number  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       City State Zip EIU Department The amount of moving expenses reimbursed must be included in your gross income reported to the Internal Revenue Service. This amount may be subject to income and social security tax withholding. In order to determine whether this reimbursement is subject to tax withholding, you must provide the following information: 1. the number of miles from your OLD home to your NEW workplace  FORMTEXT       miles 2. the number of miles from your OLD home to your OLD workplace  FORMTEXT       miles 3. subtract line 2 from line 1  FORMTEXT       miles receipts attached for total amount of moving costs = $ FORMTEXT       70% of ab45ghd e { |   ܴܿ{o[{E{=h(`MCJaJ+jh(`Mh(`M>*CJUaJmHnHu&jh(`Mh(`M>*CJUaJh(`Mh(`M>*CJaJ jh(`Mh(`M>*CJUaJhY.6hY.6CJH*aJhY.6hY%5CJH*aJhY.6hY%5>*CJaJh\45>*CJaJh\4CJaJ(jhY.6hY%CJUaJmHnHuhY.6hY%CJaJhY.6hqi 5CJaJhY.6hY%5CJaJ5gi d f 8 T V $ hXgdY% $ hXa$gdY.6 hX^gdY% hXh^hgdY.6$a$gdY.6  & ( * 4 6 8 d V X l n p z | ﮥ}iﮙU}&jh(`Mh(`M>*CJUaJ&j\h(`Mh(`M>*CJUaJh(`MCJaJ&jh(`Mh(`M>*CJUaJhY.6hY%CJH*aJh2 CJH*aJhY.6hY%CJaJ+jh(`Mh(`M>*CJUaJmHnHu&jth(`Mh(`M>*CJUaJh(`Mh(`M>*CJaJ jh(`Mh(`M>*CJUaJ %󢑅q[OCChY.6hY%5CJaJhY.6hY%CJH*aJ+jh(`Mh(`M>*CJUaJmHnHu&j0h(`Mh(`M>*CJUaJh(`Mh(`M>*CJaJ jh(`Mh(`M>*CJUaJhY.6hY%CJaJ#jhhCJUaJh(`MCJaJ"jhCJUaJmHnHu#jDhhCJUaJhCJaJjhCJUaJ$%fgPR8 : H!j!l! hXgdY.6 hXgdY.6 $ hXa$gdY.6 hXgdY%  ^d246؆uiUu&jh(`Mh(`M>*CJUaJh(`Mh(`M>*CJaJ jh(`Mh(`M>*CJUaJ&jh(`Mh(`M>*CJUaJhY.6hY%5CJaJh(`MCJaJ+jh(`Mh(`M>*CJUaJmHnHu&jh(`Mh(`M>*CJUaJh(`Mh(`M>*CJaJ jh(`Mh(`M>*CJUaJhY.6hY%CJaJ6@BDNP   & ( * 4 6 źũskiũUskũ&jvh(`Mh(`M>*CJUaJUh\4CJaJ+jh(`Mh(`M>*CJUaJmHnHu&jh(`Mh(`M>*CJUaJh(`Mh(`M>*CJaJ jh(`Mh(`M>*CJUaJhY.6hY%CJaJhY.6hY.6CJaJh(`MCJaJ jh(`Mh(`M>*CJUaJ+jh(`Mh(`M>*CJUaJmHnHuove = $  FORMTEXT       amount of reimbursement (maximum of $5000) = $  FORMTEXT       _______________________________________________ ______________ Signature Date Note: Submit this form to the appropriate Dean or Director if you have no F!H!l!t!z!"$l$$$ۺywyUhY.6hY.65CJaJhY.6hY.65>*CJaJhY.6hY.6CJH*aJhY.6hCJaJhCJaJhY.6CJaJhY.6hY.6CJaJ+jh(`Mh(`M>*CJUaJmHnHu jh(`Mh(`M>*CJUaJ&jh(`Mh(`M>*CJUaJt already requested reimbursement for your expenses. 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Courier New;WingdingsACambria Math"hAj Aj 11!8x243QHP)?\42!xx ,4REQUEST FOR PARTIAL REIMBURSEMENT OF MOVING EXPENSES Ryan Gibson Ryan Gibson  Oh+'0T ht   '8REQUEST FOR PARTIAL REIMBURSEMENT OF MOVING EXPENSES Ryan Gibson<REQUEST FOR PARTIAL REIMBURSEMENT OF MOVING EXPENSES.dot Ryan Gibson2Microsoft Macintosh Word@@v<4@v<41 ՜.+,0D px  %'Eastern Illinois Universityb 5REQUEST FOR PARTIAL REIMBURSEMENT OF MOVING EXPENSES Title  !"#$%&'()*+,-/012345789:;<=@Root Entry FzJPBData 1Tabled!WordDocument4(SummaryInformation(.DocumentSummaryInformation86CompObj` F Microsoft Word 97-2004 DocumentNB6WWord.Document.8