Standard Form No. 1012a—Revised
FORM APPROVED BY
COMPTROLLER GENERAL, U. S.
July 19, 1937 (Amended Aug. 27, 1941)
General Regulations No. 88
Voucher for Per Diem and/or Reimbursement of Expenses Incident to Official Travel
D. O. Vou. No. 278-47
Bureau No. _______________
*(Statement of account must be completely filled in by payee prior to signature, and there must not be any erasure or alteration unless initialed or signed by him)*
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General Accounting Office
PREAUDIT
Certified for payment in the
sum of $ _______________
COMPTROLLER GENERAL OF
THE UNITED STATES
By _______________
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U. S. NAVY DEPARTMENT
*(Department, bureau, or establishment)*
THE UNITED STATES, Dr., To Delbert C. Newhouse, Lt.
*(Payee)* SC, USN
Aviation Supply Depot, Pearl Harbor.
*(Address)*
Official Headquarters c/o FPO San Francisco, California
Domicile _______________ Residence _______________
*(For use of Postal Service only)*
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PAID BY
*(For use of Paying Office)*
23 DEC 1946
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FOR PER DIEM in lieu of subsistence, mileage for privately owned motor vehicle, and/or REIMBURSEMENT of travel and other expenses paid by me in the discharge of official duty from August 21, 1946, to Nov. 27, 1946, as per itemized statement within, under authority No. _______________, dated August 7, 1946, copy of which is attached,* or has been previously furnished with voucher No. _______________, paid _______________, 19____, by _______________
*(Name of disbursing officer)*
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AMOUNT
DOLLARS
CENTS
$ 254. 32
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*(Payee will NOT use this space)*
Differences
_________________________
Account verified correct for $ _______________
(Signature or initials) _______________
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MEMORANDUM
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ACCOUNTING CLASSIFICATION *(For completion by administrative office)*
| APPROPRIATION, LIMITATION OR PROJECT SYMBOL | APPROPRIATION TITLE | LIMITATION OR PROJECT AMOUNT | APPROPRIATION AMOUNT |
|---------------------------------------------|---------------------|------------------------------|----------------------|
| 1770813. | TRNP 1947 74110 | $ _______________ | $ 254.32 |
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| ALLOTMENT SYMBOL | AMOUNT | ENCUMBRANCE LIQUIDATED | COST ACCOUNT | OBJECT OF EXPENDITURE |
|------------------|--------|------------------------|--------------|------------------------|
| | $ _______________
Symbol
Amount
Symbol
Amount
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Paid by
{ Check No. _______________, dated _______________, 19____, for $ _______________
Cash, $ 254.32, on 23 Dec., 1946. }
SIGN ORIGINAL ONLY
Delbert C. Newhouse, Lt. SC, USN
*(Signature of payee)*
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*If there was no prior authority state circumstances which rendered securing prior authority impracticable.
10—23954-1