|
Name
|
| |
Todd Jamieson
|
|
Clinic
|
| |
Chicago
|
|
Week
|
| |
05/14/2023
|
|
Currency of Claim
|
| |
CAD
|
| Expenses For Claim |
|
Expenses
|
| |
| Date |
Fee |
Meal per diem |
Air Fare |
Hotel |
Car Rental |
Taxi |
Parking |
Other |
Expenses |
| Sunday |
$5.00 |
$5.00 |
$5.00 |
$5.00 |
$5.00 |
$5.00 |
$5.00 |
$5.00 |
$35.00 |
| Monday |
$70.00 |
$5.00 |
$5.00 |
$454.00 |
$545.00 |
$4.00 |
$5.00 |
$5.00 |
$1,023.00 |
| Tuesday |
$60.00 |
$60.00 |
$60.00 |
$60.00 |
$60.00 |
$5.00 |
$5.00 |
$5.00 |
$255.00 |
|
$135.00 |
$70.00 |
$70.00 |
$519.00 |
$610.00 |
$14.00 |
$15.00 |
$15.00 |
$1,313.00 |
|
|
Expense Sub Total
|
| |
$1,313.00
|
|
Fee Sub Total
|
| |
$135.00
|
|
Total Claim Submission
|
| |
$1,448.00
|
|
Claim Confirmation
|
| |
 I, Todd Jamieson agree the above amount to be accurate.
|
|