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
D. O. VOU. NO. 71907
BU. VOU. NO.
THE UNITED STATES, DR.
TO (PRINT) (Last Name) (First) (Middle) (Rank or Rating) (Title or Service No.)
OFFICIAL ADDRESS
BUREAU OF AERONAUTICS, NAVY DEPT., ROOM 244
WASHINGTON 25, D. C.
PAID BY
NO. 179
NRAO, WASH.
OCT 27 1949
J. E. LEWIS
(SYM 50 049)
(For use of Paying Officer)
AMOUNT
DOLLARS | CENTS
$ 00
PAID BY CHECK NO.
MEMORANDUM
ACCOUNTING CLASSIFICATION (For completion by Administrative Officer)
APPROPRIATION, LIMITATION OR PROJECT SYMBOL | APPROPRIATION TITLE
1701454 TRNF 1950 028 74130
FARE AUTHORIZED
FROM | TO
RATE | $ 00.00
PULLMAN | $ 00.00
TOTAL | $ 00.00
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 Carroll Newhouse | Son | 6-28-38 (11)
Anne Lisbet Newhouse | Daughter | 3-11-40 (9)
I certify that my dependents were located Springfield, Ohio (City and State) when orders directing detachment from my old permanent station were received, and departed from that place on (date) 29 September 1949 and arrived at Washington, D. C. (City and State) on (date) 30 September 1949 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 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 Delbert C. Newhouse
DATE 30 September 1949
RANK OR RATING Lieutenant
U. S. N.
*If applicable see Instruction 1.1
16—44896-1
(Instructions on reverse side of form.)