MONTHLY EXPENSE REPORT

Modern Woodmen of America

Certification
Region
I hereby certify the expenses listed on this report were incurred in the
interest of Modern Woodmen of America, and, to my knowledge,
represent expenses that are eligible as an employee business expense.
Month 2010

Signature of Agency Manager

A. OFFICE EXPENSES C. AGENT RELATED EXPENSES
1. Rent or Depreciation 1. Training Materials
2. Utilities 2. Furnished Supplies
3. Cleaning & Maintenance 3. Guest Meals
4. Taxes 4. Awards & Recognition
5. Telephone 5. Contest Expenses
6. Office Furniture 6. Region & Staff Meetings
7. Office Equipment 7. Gifts
8. Stationery & Supplies 8. Share-The-Cost Advertising
9. Postage 9. Other Advertising
10. Copy Machine & Supplies 10.
11. Computer Expenses TOTAL AGENT RELATED EXPENSES
12.
TOTAL OFFICE EXPENSES 0.00 D. PERSONAL EXPENSES
1. Dues, Fees, Subscriptions
B. TRAVEL EXPENSES 2. Educational Fees, Courses
1. Mileage: 0 miles at 0.00 3.
50.0 cents per mile. TOTAL PERSONAL EXPENSES
2. Overnight Travel: Meals, incidentals
and lodging for 0 nights 0.00
at $163 per night
3. Other than by auto:

TOTAL TRAVEL EXPENSES 0.00 TOTAL EMPLOYEE BUSINESS EXPENSES

INSTRUCTIONS:
1. Categorize business expenses into classifications indicated above and record totals.
2. Attach copies of receipts for all lodging expenses and for any other expenditures of $25 or more, including copies of agent account
charge slips. Arrange and identify receipts to the classification supported. Retain originals of all receipts for your records. Submitted
receipts will not be returned.

3. Depreciation expense on building, furniture and equipment used solely for Society business will be accepted provided the asset value
and basis of depreciation has been determined by your tax accountant to be an IRS-approved method. A depreciation schedule must be
provided by your tax accountant each year.

4. All vehicle expenses will be based upon business mileage reported multiplied by the current IRS mileage rate. Do not include mileage
between your home and office. Add the mileage on the Travel Record (reverse side) and record the total on line B.1. Do not submit
vehicle expense receipts or depreciation schedules.

5. An IRS-approved daily per diem rate will be used for overnight lodging, meals and incidentals. Add the number of overnight lodging
dates on the Travel Record and record the total on line B.2. Although lodging receipts must be submitted, do not report actual overnight
expenses incurred.

6. Personal meals not involving overnight lodging are not deductible as a business expense. Accordingly, do not include them in your
reporting. The full cost of guest meals must be recorded on the Travel Record to be accepted.
7. Retain a copy of this form for your records.
Form 1370 (Rev. 01-10)

TRAVEL RECORD
Lodging
Date Places Miles Business Purposes Guest Meals - Explanation
nights #
 TOTALS (Page 1) 0 0 $0.00

TRAVEL RECORD (Page 2)

Lodging
Date Places Miles Business Purposes Guest Meals - Explanation
nights #
TOTALS (Pages 1 & 2) 0 0 $0.00
 incurred in the
nowledge,
business expense.

0.00

0.00

0.00

0.00

agent account
ords. Submitted

d the asset value

n schedule must be

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Do not submit

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ort actual overnight

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Explanation
Explanation