ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
Moving Expense Form1
2
Complete Sections A & B
3
Form must be completed within 90 days after start date of employment. Exceptions must be reviewed/approved by the President of the University
4
Name:Date of Hire:
5
Department:Email:
6
Title:Phone Number/Extension:
7
8
Section A. Distance Test
9
# of Miles from Former Home to New Home
10
# of Miles from Former Home to Former Workplace
11
Difference - Must be > 50 miles
12
13
14
Section B: Itemized Receipts DetailsAttach original receipts
15
Meals are taxable per IRS policy and therefore are not reimbursable under Marywood policy.
16
Click on Cells Below to
17
Select Description from Dropdown ListAmountVendor
18
Transportation of Household Goods
19
Storage of Household Goods
20
Travel and Lodging from Prior to New Home
21
22
23
24
25
26
27
28
29
30
31
 $ -
32
33
34
Section C: Summary
Total Amount by Category
35
Transportation of Household Goods $ -
36
Storage of Household Goods -
37
Travel and Lodging from Prior to New Home -
38
Total Reimbursement (taxable) $ -
39
40
41
Comments:
42
o Complete worksheet
43
o Attach original receipts
44
o Submit to Human Resources
45
Employee Signature & Date
46
o Confirm employment status & eligibility
47
o Faculty
48
o Administration
49
o Review worksheet & receipts
50
o Confirm reimbursement amount for W-2 (taxable)
51
o Submit to Payroll
52
Director of Human Resources Signature & Date
53
o Payment Processed
54
o W-2 Issued by Payroll
55
Payroll Signature & Date
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100