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STANDARD FORM 1012-A
7 GAO 5300
1012-208
DEPARTMENT, BUREAU, OR ESTABLISHMENT
TRAVEL VOUCHER
MEMORANDUM
£
VOUCHER NO.
PAYEE’S NAME SCHEDULE NO.
MAILING ADDRESS PAID BY
Atlanta, Georgia
OFFICIAL DUTY STATION RESIDENCE
& Atlanta, Ga
FOR TRAVEL AND OTHER EXPENSES TRAVEL ADVANCE CHECK NO.
FROM (DATE) | TO (DATE) Outstanding $
10/27 10/28/66 .
APPLICABLE TRAVEL AUTHORIZATION (S) Amount to be applied
NO. DATE
| Balance to remain
outstanding t
TRANSPORTATION REQUESTS ISSUED
¢ | INITIALS OF | MODE, CLASS I
uasspontarion |yAGENTS.| ARMIE®: | SPRERGICE” | pare eee
Q OF TICKET | ‘TICKET | MODATIONS* FROM— ° TO—
AMOUNT Dollars Cts
CLAIMED
—> 111.10
DIFFERENCES:
APPROVED (Supervisory and other approvals when required)
Administrative Officer
NEXT PREVIOUS VOUCHER ae UNDER SAME TRAVEL AUTHORITY
b.o DATE (MONTH-YEAR)
VOUCHER NO,
. SYMBOL
Total verified correct for charge to appropriation(s)
Applied to travel adva
nee (appropriation symbol)
NET TO 3
TRAVELER
ACCOUNTING CLASSIFICATION
* Abbreviations for Pullman accommodations: MR, master room; DR, drawing room;
CP, compartment; BR, bedroom;
DSR, duplex single room; RM, roomette;
DRM, duplex roometie; SOS, single occupancy section: LB, lower berth; UB, upper berth; LB-UB, lower and upper berth; S, seat,
c48—16—78036-2
SCHEDULE OF EXPENSES AND AMOUNTS CLAIMED
PREVIOUS TEMPORARY DUTY (Complete these blocks only if in travel status immediately prior to period covered by this voucher and if admin-
istratively required) ; ; F
DEPARTURE FROM OFFICIAL STATION TEMPORARY DUTY STATION LAST DAY OF PRECEDING VOUCHER PERIO
(DATE) (HOUR) (LOCATION) (DATE OF ARRIVAL)
AUTHORIZED
MILEAGE AMOUNT CLAIMED
NATURE OF EXPENSE RATE ------ ¢
SPEEDOMETER . OF
Rravincs Sad ae MILEAGE SUBSISTENCE OTHER
Grand total to face of voucher
(Subtotals, to be carried forward if necessary) | 21.10
rAS—1§—TRAAART We caves quent rating OFFICK