VOUCHER FOR REIMBURSEMENT
FOR EXPENSES INCURRED IN DEPENDENTS TRAVEL
D. O. VOU. No. 17387
BU. VOU. No. 107
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THE UNITED STATES, DR.
TO (PRINT) — NEWHOUSE, DELBERT CLEMENT
*(Last Name)* *(First)* *(Middle)*
*(Rank or Rating)* CJPHOT USN
*(File or Service No.)* 1
OFFICIAL ADDRESS — (228) U. S. NAVAL SUPPLY CENTER
OAKLAND, CALIFORNIA
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PAID BY
SHAW, SYMBOL 540,032
NEAD, OAKLAND
JUL 18 1952
*(For use of Paying Officer)*
SYMBOL
AMOUNT
DOLLARS
CENTS
$ 452
85
PAID BY CHECK No. 4,229
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MEMORANDUM
452.85
E. FORD, ICDR SC USN
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ACCOUNTING CLASSIFICATION *(For completion by Administrative Officer)*
APPROPRIATION, LIMITATION OR PROJECT SYMBOL
APPROPRIATION TITLE
1721453.18
MPN 1952 029 74150
FARE AUTHORIZED
FROM
TO
Silver Spr., Md
El Corrito, Calif.
RAIL
PULLMAN
TOTAL
$
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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
Norma I. Newhouse
wife
Delbert C. Newhouse
son
6/28/38
Anne Lisbet Newhouse
daughter
3/14/40
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I certify that my dependents were located Silver Spring, Maryland *(City and State)* when orders directing detachment from my old permanent station were received, and departed from that place on (date) 6/28/52
and arrived at 605 San Pablo Ave.
El Corrito, Calif. on (date) 7/7/52
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: none
*Reimbursement requested herein is (is not) in accordance with par. 3 of SecNav letter of 23 Dec. 1943.*
*I hereby designate none 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 therefor has not been received; and that my statements of travel correctly reflect travel performed by my dependents.
SIGN
ORIGINAL
PAYEE
ONLY
D. C. Newhouse
DATE 7/18/52
RANK OR RATING CJPHOT
U. S. N.
*(Instructions on reverse side of form.)*
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*If applicable see Instruction 1.*
16—44896-1