NAV. S. AND A. FORM 913—REV.
Form Prescribed by
Comptroller General, U. S.
May 17, 1945
VOUCHER FOR REIMBURSEMENT
FOR
EXPENSES INCIDENT TO DEPENDENTS TRAVEL
MAIL TO BUREAU OF NAVAL PERSONNEL, WASHINGTON 25, D. C.
D. O. VOU. No. 243
BU. VOU. No.
THE UNITED STATES, DR.
TO (PRINT) HENHOUSE, Delbert C. CHIEF, USN 177283
(Last Name) (First) (Middle) (Rank or Rating) (File or Service No.)
OFFICIAL ADDRESS Utility Squadron FIVE
Navy 943, c/o FPO, San Francisco, Calif C-1
CERTIFICATE OF DEPENDENCY OF CHILDREN
J. G. HARPER
SYMBOL 59043
(For use of Paying Officer)
AMOUNT
DOLLARS | CENTS
--- | ---
$ 109.20
PAID BY CHECK No.
MEMORANDUM
109.20 J. G. HARPER, LT, SC, USN
ACCOUNTING CLASSIFICATION (For completion by Administrative Officer)
APPROPRIATION, LIMITATION OR PROJECT SYMBOL
APPROPRIATION TITLE
1743453.18
029 74150
22/31600
FARE AUTHORIZED
FROM Oakland, Cal TO Portland, Oregon
Not to exceed:
RAIL 728 miles @15¢
PULLMAN
TOTAL $ PAID $109.20 CASH
CERTIFICATION OF CLAIMANT (FILL IN ALL BLANKS BELOW WHERE APPLICABLE)
Payment is requested for transportation for travel performed by the following, who were my dependents on the effective date of orders directing this change of station.
NAME
RELATIONSHIP
DATE OF BIRTH OF CHILDREN
Hanna I. HENHOUSE
wife
Delbert C. HENHOUSE
son
6/20/38
Anne L. HENHOUSE
daughter
9/14/40
I certify that my dependents were located 1948 Derby Street Berkeley, Calif (City and State) when orders directing detachment from my old permanent station were received, and departed from that place on (date) 6/12/54 and arrived at 3581 S.E. Grant Court Portland, Oregon (City and State) on (date) 6/14/54 I further certify that my dependents traveled at my own expense, and that the child (children) named above is (are) the legitimate child (children) of the officer or man concerned. (IF CHILD (CHILDREN) IS (ARE) STEP OR ADOPTED, FILL IN CERTIFICATE ON REVERSE SIDE.)
I certify that the travel covered by this claim represents the entire travel of all my dependents which has been or will be made on this change of station except as follows:
*Reimbursement requested herein is (is not) in accordance with par. 3 of SecNav letter of 23 Dec. 1943.
*I hereby designate Portland, Oregon as point to which transportation of dependents is desired.
I certify that this account and schedule annexed are true and just in all respects, that payment thereof has not been received and that my statements of travel correctly reflect travel performed by my dependents and at the places claimed and listed above I have actually established a homide residence for my dependents.
SIGN
ORIGINAL (PAYEE) ONLY
Delbert C. HENHOUSE
DATE
RANK OR RATING CHIEF
U. S. N.
*If applicable see Instruction 1.
16—44896-1
(Instructions on reverse side of form.)