ࡱ> VXU >;bjbj kFtjtj $PdiL)cccc>DFdz(|(|(|(|(|(|(+k.P|(E>>|(cc("""Rccz("z("":&','c>^R' f((0)\'..nJ.''0.'L6",,Xf|(|(!X). W: Pre-Approval for Reimbursement of 3rd Party Lodging Reimbursement for lodging in an establishment that is being rented out by a third party is not allowed unless approved by OSBM in advance. Requests for third party lodging must provide evidence of savings to the State. An exception may be granted for requests that do not show a savings with sufficient justification to support the necessity for third party lodging. Applicants must provide their budget officer and OSBM all details regarding the arrangement, including (1) the amount to be charged, (2) the length of stay, and (3) contact information. A signed rental agreement must be presented to receive reimbursement (Section 5.1.8 Third Party Lodging, State Budget Manual). PLEASE FILL OUT A SEPARATE FORM FOR EACH LEASE AGREEMENT Campus:  FORMTEXT       Dates (# nights):  FORMTEXT       Funding: General Fund Budget Code OR Name of Grant/Other Source  FORMTEXT       Will the campus be billed directly?  FORMTEXT       Purpose of Visit:  FORMTEXT       Name(s) of Individual(s) Covered on Lease Agreement, attach additional pages if neededAmount to be Reimbursed1,2Estimated Daily Rate FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      TOTAL REIMBURSEMENT REQUEST3 FORMTEXT       1If the unit is shared by several individuals, split cost evenly (or pro-rate if lengths of stay vary). 2If the lease agreement calls for payment in a foreign currency, do not convert into USD. List the cost as stated on the lease (e.g., CZK 8,800). Approval will be determined based on exchange rate at the time of approval. 3Total must match lease agreement. If it does not, please provide an explanation:  FORMTEXT  #%34u ( , D H ]      ! ʿʿʿʿʿʳʧʏynch~hCJaJh~hIUCJaJhTh7SCJaJhThCJaJh~h5CJaJh~hTCJ\aJh~h CJ\aJh~h 5CJaJh~h4QCJaJh~h CJaJh~h 5>*CJH*aJh~h 5>*CJaJh~h5>*CJaJ!4    \ b    $Ifgd)a$$d&dNPa$gdgd gd gd! " , - .       , 4 6 J L N P R T V X Z \ ^ ` b ﹹﮣmZZZZZNh~h4Q>*CJaJ%jh'>*CJUaJmHnHu&jth'h*>*CJUaJh'>*CJaJjh'>*CJUaJh~hTCJaJh~h4QCJaJh~hCJaJ+jh'h'>*CJUaJmHnHu&jh'h*>*CJUaJh'h'>*CJaJ jh'h'>*CJUaJ        X Z \ ^ r t v x z | ~ м٩瞓t٩h]Uh'CJaJh~h~CJaJh~h4Q>*CJaJ&j\h'h*>*CJUaJh~hIUCJaJh~h)aCJaJh~h4QCJaJ%jh'>*CJUaJmHnHu&jh'h*>*CJUaJh'>*CJaJjh'>*CJUaJh~hTCJaJh~hT5>*CJaJ @󼱱xiWi#jh~BGhbCJUaJjh~BGhCJUaJh~BGh~CJH*aJh~BGhZgCJH*aJh~BGhCJaJh~BGhZgCJaJh~h)aCJaJh~h~CJaJh~h4QCJaJ"jh'CJUaJmHnHu#jh'h*CJUaJh'CJaJjh'CJUaJ:bqhhh $Ifgd)akdD$$IflF,!i T t0U"6    44 layt~BG  (*,.02468:<PRTVXZ\^`bdfz|~ƴƢƐ~#j8h~BGhbCJUaJ#jh~BGhbCJUaJ#jh~BGhbCJUaJ#jIh~BGhbCJUaJh~BGhCJaJh~BGhZgCJaJjh~BGhCJUaJ(jh~BGhCJUaJmHnHu1bdqhhh $Ifgd)akd3$$IflF,!i T t0U"6    44 layt~BG "$&(*,.0DFHJLNPRTVXƴƢƐ~#jh~BGhbCJUaJ#j)h~BGhbCJUaJ#jh~BGhbCJUaJ#jh~BGhbCJUaJh~BGhCJaJh~BGhZgCJaJjh~BGhCJUaJ(jh~BGhCJUaJmHnHu1.Vqhhh $Ifgd)akd"$$IflF,!i T t0U"6    44 layt~BGVXqhhh $Ifgd)akd$$IflF,!i T t0U"6    44 layt~BGXZnprtvxz|~  "𾾾𾾾𾾾𳳃uh~BGh~5CJH*aJh~BGhZg5CJaJ#j h~BGhbCJUaJ#j h~BGhbCJUaJh~BGhZgCJaJ(jh~BGhCJUaJmHnHu#jh~BGhbCJUaJh~BGhCJaJjh~BGhCJUaJ' 46qe\\ $Ifgd)a $$Ifa$gd~BGkd $$IflF,!i T t0U"6    44 layt~BG"$&(*,.02468:<J 0@KN 89:D޾umamjhCJUaJhCJaJh~hTCJaJh~hT 5CJaJh~hT CJaJh~CJaJh~h~CJaJh~CJH*aJh~hIUCJaJh~BGhZgCJaJ(jh~BGhCJUaJmHnHujh~BGhCJUaJ#j h~BGhbCJUaJ%68:4KFAAFFFgd~gdIUkd $$IflF,!i T A t0U"6    44 lapyt~BGDEF44444 4 44444444444\5^5`55566666 6·sk`Tjh'CJUaJh~hT CJaJh~CJaJh~hZg0JCJaJ#jo h~hZgCJUaJjh~hZgCJUaJh~hZgCJaJh~hTCJaJh~h4QCJaJh~hIUCJaJ"jhCJUaJmHnHuUjhCJUaJ#j hhbCJUaJ      Does the daily rate exceed the State approved daily rate? (Consult State Budget Manual @  HYPERLINK "http://www.osbm.state.nc.us/files/pdf_files/BudgetManual.pdf" http://www.osbm.state.nc.us/files/pdf_files/BudgetManual.pdf for current rates.)  FORMCHECKBOX No a Please submit this form along with a copy of the lease agreement.  FORMCHECKBOX Yes a Go to question #2. Does the daily rate exceed standard mid-range hotel rates in the area?  FORMCHECKBOX No a Submit this form, a copy of the lease agreement and three hotels for comparison.  FORMCHECKBOX Yes a Go to question #3. What extenuating circumstances support this request? Please provide sufficient documentation and an explanation to justify an exception to State Budget policy.  FORMTEXT           Office of State Budget & Management 116 West Jones Street Raleigh, NC 27603, (919) 807-4700, www.osbm.state.nc.us/ 44446667777t8886:::<:@:B:F:H:L:N: hh^h`gdO hh^h`gdT & F hh^hgdTgd  6&6(6*6,6.6064666666666666777777777ϵĪujjbWE#jh'h*CJUaJh~hZgCJaJh~CJaJh~h;)CJaJh~hOCJOJQJaJ#jdhhbCJUaJhCJaJjhCJUaJh~hOCJaJh~hTCJOJQJaJh~h7SCJaJh~hTCJaJjh'CJUaJ#j hhbCJUaJh'CJaJ77778t8v88888888 :::$:&:(:*:,:.:0:2:4:6:8:::<:>:@:B:D:F:H:J:L:N:ѿ贬|||||qieieieiehajhaUh~hZgCJaJ"jhCJUaJmHnHu#jhhbCJUaJjhCJUaJhCJaJh~h;)CJaJ#jLh'h*CJUaJh'CJaJh~hOCJOJQJaJh~hOCJaJjh'CJUaJ&N::::; ;8;:;<;>;h~hZgCJaJh hTgCJaJhhhTgCJaJhTg'hhTg6@CJ(OJQJ^JaJ N::::8;:;<;>; & F hh^hgdTgdh$hdh^ha$gdh$a$gd21h:p7S/ =!"#$% 5 01h:p7S/ =!"#$% tDText1tDText2tDText3tDText4tDText5$$If!vh#v#vi #vT:V l t0U"655i 5Tyt~BGtDText6tDText7vDText17$$If!vh#v#vi #vT:V l t0U"655i 5Tyt~BGtDText8tDText9vDText10$$If!vh#v#vi #vT:V l t0U"655i 5Tyt~BGvDText11vDText12vDText13$$If!vh#v#vi #vT:V l t0U"655i 5Tyt~BGvDText14vDText15vDText16$$If!vh#v#vi #vT:V l t0U"655i 5T/ yt~BGvDText20$$If!vh#v#vi #vT:V l A t0U"655i 5Tpyt~BGvDText18DyK =http://www.osbm.state.nc.us/files/pdf_files/BudgetManual.pdfyK http://www.osbm.state.nc.us/files/pdf_files/BudgetManual.pdfyX;H,]ą'ctDCheck1tDeCheck2tDeCheck3tDeCheck4vDText19x2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@66666_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontRi@R  Table Normal4 l4a (k (No List VoV Default 7$8$H$!B*CJ_HaJmH phsH tH jj 4Q Table Grid7:V06U@6 Zg Hyperlink >*B*ph4@"4 Header  !4 @24 Footer  !PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vzt7.??Źڨd/L+[梃 _¯UjyA_/֖j-A %4\/%ި+K|h(Kmgk):b| H$Y 9DZ.6)A2&`RV!*_[`dI+^DL-)>qfoΟ~_'ҨrQrW_ƿw!pƦ7/_zqԵbp@m ?ItDl,(CjLQc׎O9!N@Iw{Xe3b|`:2˭A9Tn$ءy@Q&Q3,;sg8v%= CN4I ~> zHzw0u $J}*;(wL|$C޳q-!1,hEX>ZN yݾKt l&;HPm%6sq !&}] ~@Lw?%q d98@7C̜mia_Y㩓b8F vB{cNQqsu;6~@VƾzXU+f:OllD,E|=mVePاcGxe_+gj=HSԳ;{yи½|mHmA`0D_cU\+w/ 9MOJK:WnǯIUsffn`<"K*2:&w4]3۸cB/br;}̸uF̘G}ҙ3>-=k&ڂE%睸 |Te6pp1GZ&L~AdNPjĢP gFFz٫[ euRTVxC'c*ibQTz:"dC%1!4ZŲR?rՔ)Zf\5GμMO20V4'|:xt&Ԯiv +nD?TWq]_7.u)S 4?⦾@3;S,8;^K=7>̌cC ^$77&%Bn"cy@I K?L'CWc%WSc#^w}ܓ߭ei)$ Z`%v]:Blqwae&De*2JǐYG4OPQRlnຠtSi832IQ QrZ.afٽ\HYʚU6iaT&ly*o]M̹Qh2/woQoPSJŪ[lDY&`Riڊ0z۶ܫ/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!wG theme/theme/theme1.xmlPK-! ѐ'Q theme/theme/_rels/themeManager.xml.relsPK]L  0F04F 22! X"D 67N:>;  !bV64N:>; "!-3HTZ)/1=CEQWZflnzgsy#`xG W {  FFFFFFFFFFFFFFFFFFFXG G G G F8@0(  B S  ?Text1Text2Text3Text4Text5Text6Text7Text17Text8Text9Text10Text11Text12Text13Text14Text15Text16Text20Text18Check1Check2Check3Check4Text19"H 2F[ohyH |   4[0DXmzX           >*urn:schemas-microsoft-com:office:smarttags PostalCode8*urn:schemas-microsoft-com:office:smarttagsCity:*urn:schemas-microsoft-com:office:smarttagsStreet;*urn:schemas-microsoft-com:office:smarttagsaddress9*urn:schemas-microsoft-com:office:smarttagsState    IR   33!4::H[Nq01DEXZmn6FGeefz||}}~~uvxC E F z      oS2Z~Q8r&Ƌ^`o(. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.^`CJOJQJo(^`CJOJQJo(opp^p`CJOJ QJ o(@ @ ^@ `CJOJ QJ o(^`CJOJ QJ o(^`CJOJ QJ o(^`CJOJ QJ o(^`CJOJ QJ o(PP^P`CJOJ QJ o(oSQ8r          @ @N $O$O0}N OTgaT ^';)~BG7SIUZg/cb,4Q~S,T%)a *hV&.xQ   @@...t @ $@4Unknown G.[x Times New Roman5Symbol3. .[x Arial?Wingdings 3MCentury Schoolbook3.@TungaC. Aptos Display3. Aptos?= .Cx Courier New;WingdingsA$BCambria Math"1hgg!20 3Q@P ? ! xxMIC  JWallace Anita Hall  Oh+'0`   ( 4@HPX  JWallace Normal.dotm Anita Hall2Microsoft Office Word@@H@H ՜.+,D՜.+,< hp  nc state government   Title 8@ _PID_HLINKSAW,9=http://www.osbm.state.nc.us/files/pdf_files/BudgetManual.pdf  !"#%&'()*+,./0123456789:;<=>?@ABCDFGHIJKLNOPQRSTWRoot Entry FH>YData $61Table-.WordDocumentkFSummaryInformation(EDocumentSummaryInformation8MCompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q