\documentclass[10pt]{article}
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\begin{document}

\begin{center}

{\bf Department of Mathematics: Expense Report Summary}

\end{center}

\begin{Form}

\begin{tabular}{|l|r|l|l|}
\hline
Expense categories: &Amount &Tax Code &G/L Acct.\\
\hline
Airfare bought in Canada (to Canada or US) &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a1]{}}} &\cellcolor{verylightgray}i6 &\cellcolor{verylightgray}84\_010
\\
\hline
Airfare other &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a2]{}}} &\cellcolor{verylightgray}i0 &\cellcolor{verylightgray}84\_010
\\
\hline
Accommodation in Canada &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a3]{}}} &\cellcolor{verylightgray}ie &\cellcolor{verylightgray}84\_020
\\
\hline
Accommodation outside Canada &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a4]{}}} &\cellcolor{verylightgray}i0 &\cellcolor{verylightgray}84\_020
\\
\hline
Allowances per diem in Canada &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a5]{}}} &\cellcolor{verylightgray}i6 &\cellcolor{verylightgray}84\_030
\\
\hline
Allowances per diem outside Canada &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a6]{}}} &\cellcolor{verylightgray}i0 &\cellcolor{verylightgray}84\_030
\\
\hline
Allowances kms $\times$ {\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=b7]{}}}&{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a7]{}}} &\cellcolor{verylightgray}&\cellcolor{verylightgray}84\_040
\\
\hline
Railway in Canada &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a8]{}}} &\cellcolor{verylightgray}&\cellcolor{verylightgray}84\_050
\\
\hline
Railway outside Canada &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a9]{}}} &\cellcolor{verylightgray}&\cellcolor{verylightgray}84\_050
\\
\hline
Car rental in Canada &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a10]{}}} &\cellcolor{verylightgray}&\cellcolor{verylightgray}84\_060
\\
\hline
Car rental outside Canada &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a11]{}}} &\cellcolor{verylightgray}&\cellcolor{verylightgray}84\_060
\\
\hline
Taxi in Canada &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a12]{}}} &\cellcolor{verylightgray}i6 &\cellcolor{verylightgray}845000
\\
\hline
Taxi outside Canada &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a13]{}}} &\cellcolor{verylightgray}i0 &\cellcolor{verylightgray}845000
\\
\hline
Bus in Canada &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a14]{}}} &\cellcolor{verylightgray}&\cellcolor{verylightgray}84\_050
\\
\hline
Bus outside Canada &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a15]{}}} &\cellcolor{verylightgray}i0 &\cellcolor{verylightgray}84\_050
\\
\hline
Gasoline in Canada &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a16]{}}} &\cellcolor{verylightgray}&\cellcolor{verylightgray}84\_080
\\
\hline
Gasoline outside Canada &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a17]{}}} &\cellcolor{verylightgray}i0 &\cellcolor{verylightgray}84\_080
\\
\hline
Research related purchases in Canada &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a18]{}}} &\cellcolor{verylightgray} &\cellcolor{verylightgray}
\\
\hline
Research related purchases outside Canada &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a19]{}}} &\cellcolor{verylightgray} &\cellcolor{verylightgray}
\\
\hline
Miscellaneous: {\mbox{\TextField[maxlen=150,align=0,height=10pt,width=150pt, name=t20]{}}}
&{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a20]{}}} &\cellcolor{verylightgray}&\cellcolor{verylightgray}
\\
\hline
{\mbox{\TextField[maxlen=200,align=0,height=10pt,width=200pt, name=t21]{}}}&{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a21]{}}} &\cellcolor{verylightgray}&\cellcolor{verylightgray}
\\
\hline
{\mbox{\TextField[maxlen=200,align=0,height=10pt,width=200pt, name=t22]{}}}&{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a22]{}}} &\cellcolor{verylightgray}&\cellcolor{verylightgray}
\\
\hline
{\mbox{\TextField[maxlen=200,align=0,height=10pt,width=200pt, name=t23]{}}}&{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a23]{}}} &\cellcolor{verylightgray}&\cellcolor{verylightgray}
\\
\hline
{\mbox{\TextField[maxlen=200,align=0,height=10pt,width=200pt, name=t24]{}}}&{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a24]{}}} &\cellcolor{verylightgray}&\cellcolor{verylightgray}
\\
\hline
{\mbox{\TextField[maxlen=200,align=0,height=10pt,width=200pt, name=t25]{}}}&{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=a25]{}}} &\cellcolor{verylightgray}&\cellcolor{verylightgray}
\\
\hline
Subtotal 1 &{\mbox{\TextField[maxlen=40,keystroke={AFNumber_Keystroke(2, 0, 1, 2, true);},align=2,height=10pt,width=45pt,name=subtotal1,
calculate={AFSimple_Calculate("SUM" , new Array ( "a1", "a2", "a3", "a4", "a5", "a6", "a7", "a8", "a9", "a10", "a11", "a12", "a13", "a14", "a15", "a16", "a17", "a18", "a19", "a20", "a21", "a22", "a23", "a24", "a25") ;)},
]{}}} &\cellcolor{verylightgray}&\cellcolor{verylightgray}
\\
\hline
\end{tabular}
\

\begin{tabular*}{\textwidth}{ll}
\rowcolor{verylightgray}
Document Number:\ \underline{\ \ \qquad\qquad\qquad\qquad\qquad}
&Date: \ \underline{\ \ \qquad\qquad\qquad\qquad\qquad}

\end{tabular*}


\end{Form}

\end{document}