Travel Disclosure

Submission State

Official’s First Name

Official’s Last Name

Official’s Position with the State

Destination Visited

Travel Start Date

Travel End Date

Purpose of Travel

Source(s) of Expenses Paid (include for lodging and meals)

Amount Spent for Expenses (include lodging and meals)

I certify the information provided in this travel disclosure form is true, correct, complete, and of my own personal knowledge. I further certify I am the public official named or the public official’s authorized representative and will fully cooperate in the process regarding the filing of this travel disclosure form.

Signature (typed name is acceptable)

Signature Digital

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Travel Disclosure

Quick Guide

Example 1

Example 2