Jury Duty Mileage & Expense Reimbursement Log (PDF)

Track mileage, parking, meals, and other jury duty expenses for reimbursement requests or employer records.

Court name

Case / juror number (optional)

Juror name

Date range

Mileage rate (optional)

Expense entries

Log mileage, parking, meals, and other reimbursable items.

Expense 1

Date

Expense type

Miles driven

Expense amount

Description / notes

Receipt attached

Mileage subtotal0.00

Non-mileage subtotal0.00

Grand total0.00

I certify that the information above is true and accurate.

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