NEW MEXICO DEPARTMENT OF LABOR

INTRASTATE TRAVEL AUTHORIZATION

NAME:______________________________ TITLE: ________________________
I COST CENTER NAME: ______________ DATE: _________________________
COST CENTER #:_____________________

AUTHORIZATION IS REQUESTED TO INCUR THE FOLLOWING TRAVEL EXPENSE, IN ACCORDANCE

WITH DFA REGULATION NUMBER 90-2, DEEMED NECESSARY TO THE PERFORMANCE FO OFFICIAL
DUTIES, DURING THE PERIOD__________, 20__________TO _______________, 20__________
II

EMPLOYEE SIGNATURE: DATE: ____________________

ESTIMATED DATES DESTINATION AND PURPOSE OF TRIP

III

TOTAL ESTIMATE COST: $____________________

REQUEST FOR A TRAVEL ADVANCE TRAVEL TO BE PAID FROM

NON-NMDOL FUNDS
IV REQUEST FOR REIMBURSEMENT REQUEST FOR RENTAL CAR
OF ACTUAL EXPENSES
AIRFARE

FUNDING SOURCE:
ENTER PROJECT AND FUNCTION CODE THE TRAVEL EXPENSE IS TO BE CHARGED TO. IF MORE
THAN ONE CODE INDICATE % THAT IS TO BE APPLIED TO EACH.

V 1)__________ __________ _____% 3)__________ __________ _____%

2)__________ __________ _____% 4)__________ __________ _____%

USE OF PERSONAL VEHICLE ONLY:

I CERTIFY THAT I HAVE THE MINIMUM INSURANCE COVERAGE FOR LIABILITY PROPERTY DAMAGE
AND UNISURED MOTORIST WITH:
COMPANY: _____________________________________________
VI POLICY COVERAGE DATE: FROM _____________________TO_______________

EMPLOYEE SIGNATURE: DATE:__________

SUPERVISOR: DATE:__________ APPROVE

DISAPPROVE

BUREAU CHIEF: DATE:__________ APPROVE

VII DISAPPROVE

DIVISION DIRECTOR: DATE:__________ APPROVE

DISAPPROVE

SECRETARY: DATE:__________ APPROVE

DISAPPROVE
SEE INSTRUCTIONS ES100.8
001-0058 (REV 7/90)
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