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{"sheet":"STATEMENT OF COMPLETED","index":0,"n_rows":47,"n_cols":17,"rows_kept":47,"cut":false,"hidden":false,"merged":[[46,6,46,8]]}
[null,null,null,null,null,"     Statement  of  Completed  Travel"]
[null,null,null,null,null,"Department of Accounting and General Services"]
[]
[null,null,"Check One:",null,null,"Within State (overnight)",null,null,null,null,null,"Within State (same day  travel)"]
[null,null,null,null,null,"Out  of  State"]
[null,"Division / Branch :",null,null,null,null,null,null,null,null,null,null,null,null,null,"Date:"]
[]
[null,"In accordance with Section 78-15, HRS, as amended, and the Comptroller's Rules and Regulations, I  certify"]
[null,"that I traveled from ",null,null,null,null,null,null,null,"to ",null,null,null,null,"on  official business"]
[]
[null,"The travel was authorized by:(see attached)",null,null,null,null,null,null,null,"Request for Intra-State Travel",null,null,null,null,null,null,"TAF / Memo"]
[]
[null,null,null,"Date of Departure:",null,null,null,"Time:",null,null,null,null,"Return Date:",null,null,"Time:"]
[]
["A.","Computation  of  Per  Diem  Allowance :  ( overnight / out of state - instructions on reverse )"]
[null,"  Depart Day",null,null,"Full Days",null,null,"Return Day",null,null,"   Total Days",null,null,"Rate"]
[null,null,null,"+",null,null,"+",null,"=",null,null,null,"X",null,"=","$"]
[null,null,null,"+",null,null,"+",null,"=",null,null,null,"X",null,"=","$"]
[null,"Computation of Travel Allowance  ( same  day  travel )",null,null,null,null,null,null,null,null,null,null,null,null,"=","$"]
[]
["B.","Computation of Subsistence Allowance when per diem is not provided:"]
[null,"Travel beginning before 8:00  am",null,null,null,null,null,null,null,null,"Breakfast",null,"(8% of per diem)   *",null,null,"$"]
[null,"Travel beginning before 12:00 noon or return",null,null,null,null,null,null,null,null,"Lunch",null,"(12% of per diem) *",null,null,"$"]
[null,null,null,null,null,null,"after 12:30 pm"]
[null,"Travel ending after 7:00 pm",null,null,null,null,null,null,null,null,"Dinner",null,"(20% of per diem) *",null,null,"$"]
[]
["C.","DEDUCT meals furnished to traveler in connection with approved travel:"]
[null,"Number of meals furnished:",null,null,null,null,null,null,null,null,"Breakfast",null,"(8% of per diem)   *",null,null,"$","(                     )"]
[null,null,null,null,null,null,null,null,null,null,"Lunch",null,"(12% of per diem) *",null,null,"$","(                     )"]
[null,null,null,null,null,null,null,null,null,null,"Dinner",null,"(20% of per diem) *",null,null,"$","(                     )"]
[]
["D.","Other allowable expense (Itemize and attach  receipts)"]
[null,null,null,null,null,null,null,null,null,null,null,null,"$"]
[null,null,null,null,null,null,null,null,null,null,null,null,"$"]
[null,null,null,null,null,null,null,null,null,null,null,null,"$"]
[null,null,null,null,null,null,null,null,null,null,null,null,"$",null,null,"$"]
["E.","TOTAL  CLAIM:",null,null,null,null,null,null,null,null,null,null,null,null,null,"$"]
["F.","DEDUCT from  TOTAL  CLAIM  advance  by  State  Warrant  Voucher "]
[null,null,null,null,null,null,null,"Summary Warrant Voucher  (DBRN #)",null,null,null,"Dated:",null,null,null,"$","(                     )"]
["G.","TOTAL DUE TO EMPLOYEE OR  STATE",null,null,null,null,null,null,null,null,null,null,null,null,null,"$"]
[]
[null,"Submitted  by:",null,null,null,null,null,null,null,null,null,null,"Approved  by:"]
[null,null,null,null,null,null,"Signature"]
[]
[null,"Date",null,null,null,null,"Typed  Name",null,null,null,null,"Date",null,null,"  Title"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"*  Rounded  to  the  nearest  dollar"]
[null,"BU#",null,null,null,null,"Social  Security  # (last four)"]

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["Computation of  per  diem  days:"]
[]
["If time of departure or return is:",null,null,null,"       Then depart day is:",null,null,null,"     and return day is:"]
["       12:01 am - 6:00 am",null,null,null,null,"1  day",null,null,null,"1/4  day"]
["        6:01 am  -  noon",null,null,null,null,"3/4  day",null,null,null,"1/2  day"]
["        2:01 pm  -  6:00  pm",null,null,null,null,"1/2  day",null,null,null,"3/4  day"]
["        6:01 pm  -  midnight",null,null,null,null,"1/4  day",null,null,null,"1  day"]
[]
[]
["Illustration  for  inter-island  travel:"]
[]
["Departure Date:",null,"05/06/02","Time:   8:10  am",null,null,"Return Date:   05/10/02   ",null,null,"Time:   5:45 pm"]
[]
[]
["Depart Day:",null,"Full  Days:",null,"Return Day:",null,"Total Days:",null,"Rate *"]
["3/4","+","3","+","3/4","=","4 1/2","X","$ 80.00","=","$ 360.00"]
[]
[null,null,null,"* Rate:  as per applicable collective bargaining agreements"]