RECEIPTS DISBURSEMENTS
1. CASH ON HAND BEGINNING OF PERIOD $ 3. VOUCHER NUMBER DATE DESCRIPTION AMOUNT
2. RECEIPT NUMBER DATE DESCRIPTION INVOICES $ 400.00
27 Dec. Advance MULTRA Sub 52 400.00
1962 Inv. 20
I certify that to the best of my knowledge and belief the amount shown above was disbursed to or for agency authorized activities and services or material have been received, and further advances as may be directed by the Agency are warranted. The documents upon which this statement is based are maintained in the files of TSD for security reasons and will be made available for review by the Certifying Officer at his request.
4. REFUNDED HEREWITH CASH CHECK MONEY ORDER
5. CASH ON HAND END OF PERIOD
TOTAL TO ACCOUNT FOR $ 400.00 TOTAL ACCOUNTED FOR $ 400.00
I CERTIFY FUNDS ARE AVAILABLE APPROVED I certify that the expenditures listed hereon and on any attachments were incurred for official purposes of a confidential nature, that payment or credit therefor has not been received, and that his accounting is true and correct. SIGNATURE OF PAYEE
OBLIGATION REFERENCE NO. CHARGE ALLOTMENT NO. DATE 8-JAN.1933
DATE SIGNATURE OF AUTHORIZING OFFICER CERTIFIED FOR PAYMENT OR CREDIT
DATE SIGNATURE OF CERTIFYING OFFICER
SPACE BELOW FOR EXCLUSIVE USE OF FINANCE DIVISION
REVIEWED BY VOUCHER NO. 7-12
23-39 DESCRIPTION • ALL OTHER ACCOUNTS
DESCRIPTION • A/P ITEMS 13-33
DESCRIPTION • ADVANCE ACCOUNTS 13-24
FORM 282 USE PREVIOUS
6-57 EDITIONS.