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NELSON COUNTY BOARD OF EDUCATION

Educetiona and Extra Curricular Trip Invoice -

NAME OF natn Kea Fi Ike 150 va} Waal, Bad let BUS NUMBER , 104 + S/
DaTeortAP _ /P-25° + JN=2b

scHoor_297" Outoloor Jama Cov DEPARTMENT
pestinaTION OLY. Ark DinwerTealy Foyp ;

: Ps 3 a tS
MILEAGE- DEPARTURE @VIniryunn Chare 2S. Adley Rr Lach bus = /0d:

MILEAGE - RETURN TOTAL MILES TRAVELED

TIME DEPARTURE TIME RETURN GALLONS OF GASOLINE TO FILL UP
3 __ ON RETURN

DRIVING TIME =
Hours x Rate

WAITING TIME Nels 23% 5 hs = 67, 7S

, Hours x Rate ~-7 y 9 G0
TOFAL AMOUNT DUE DRIVER Adri rivevs ot 19,??T z AW) oe 3

DRIVER??TS SIGNATURE

APPROVED FOR PAYMENT BY Ent pad v rp. SA. Le
? Director of Transportation i 2

atc ete Dus rev | J OD,

Director of Transportation - White

Sioa pg | P| rive as | / 4 7 '
SY 7 me

a ABIL AL

Reta alu es 2 #3 |

70

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Disrveqnrd any bill, you vecieved below This owe
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