STATUS OF OUTSTANDING ADVANCES I agree that I will fully account for this advance by submission of voucher and refund of any unexpended balance to the reporting point stated and by the due date checked below. In the event of my failure to so account and refund any unexpended balance, I authorize deduction from my salary to affect settlement. DUE DATE ✓
DATE AMOUNT UNACCOUNTED BALANCE DATE DUE DATE
FINANCE DIVISION
CHECKS HEADQUARTERS ON ARRIVAL AT DESTINATION ON OR ABOUT
RELIVE MONTHLY - ON THE LAST WORKDAY OF EACH MONTH
REQUEST OF OFFICER
DATE SIGNATURE APPROVING OFFICER I acknowledge receipt of funds in the amount stated here under to be used for the purpose stated and accounted for as shown above.
I CERTIFY FUNDS ARE AVAILABLE Sidney Gottlieb AC/TSD DATE AMOUNT
OBLIGATION REFERENCE NO. CERTIFIED FOR PAYMENT OR CREDIT
CHARGE ALLOTMENT NO. 2125-1390-3902 DATE AUTHORIZED CERTIFYING OFFICER SIGNATURE OF ADVANCEE
DATE SIGNATURE
SPACE BELOW FOR EXCLUSIVE USE OF FINANCE DIVISION
DESCRIPTION-ALL OTHER ACCOUNTS 13-33 REVIEWED BY VOUCHER NO. 7-12
DESCRIPTION-ADVANCE ACCOUNTS 13-27 28-33 T/A NO. P.O. NO. 32-30 DIV. PROJECT NO. 34-39 STATION CODE PROP. NO. 40-42 EXPEND CODE 43 FUNDS 45-48 PAY PER. LID. CODE 47-52 OBLIG. REF. NO. ADVANCE ACCT. NO. 53 CAYR 54-57 GENERAL LEDGER ACCT. NO. 58-67 ALLOT. OR COST ACCT. NO. 68-70 DUE DATE 71-80 AMOUNT
OBJECT CLASS
DEBIT CREDIT