MODR Standard Mileage Reimbursement Form

Please Note

Missouri Baptist Disaster Relief (MODR) agrees to reimburse MODR Trained Volunteers at the IRS Charitable Rate (currently $.14/mile) if the following conditions are met:

The vehicle contained two or more volunteers.
The vehicle traveled in excess of 200 miles from home per event (only the miles above 200 will be reimbursed).
The vehicle was traveling on an official MODR callout.
The reimbursement request is made within 30 days of deployment.
The bugeted funding for reimbursements has not been depleted.
The reimbursement request is made with the appropriate MODR mileage reimbursement form.

If any one of these conditions are not met, we will not be able to process a reimbursement. On rare occasions exceptions may apply per the MODR State Director.

Some Disaster Relief volunteers may need to fill out a different form:

For questions on how this policy affects your taxes, please consult your tax advisor.

DR Standard Mileage Reimbursment Form

Name(Required)

First Last

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Names of others in the vehicle:(Required)

For which callout do you need a mileage reimbursment?(Required)

When did this travel begin?(Required)

For how many miles do you need a reimbursement?(Required)

Note: Only list the distance you traveled beyond 200 miles.