VOUCHER FOR REIMBURSEMENT FOR TRAVEL
(DEPENDENTS) MILITARY PERSONNEL
D. O. VOUCHER NO. 17288
BUREAU VOUCHER NO. 18061
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DEPARTMENT, BUREAU OR ESTABLISHMENT
NAVY DEPARTMENT
PAYEE (Name)
Belbert G. Newhouse, USN, 177283
MAILING ADDRESS
USNAS PENSACOLA, FLORIDA
OFFICIAL DUTY STATION
NAS PENSACOLA, FLORIDA
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CERTIFICATION OF CLAIMANT
Payment is requested for travel by persons listed below who were my dependents on the effective date of applicable orders or other authority; such travel was actually performed with the intent of establishing a bona-fide residence. (If any of these be other than a lawful wife or unmarried legitimate child under 21 years of age of a MALE member, complete appropriate certificate on reverse.)
NAME
RELATIONSHIP
BIRTH DATES OF CHILDREN
Dorothy Isobel Newhouse
wife
Belbert G. Newhouse
son
6-28-38
Anne Lisabet Newhouse
daughter
3-14-40
LOCATION OF DEPENDENTS (On date of receipt of orders/authority - street address, city, state)
2503 SE 1st Ave, Portland, Oregon
DATE OF DEPARTURE
7-1-56
DESIGNATED DESTINATION OF DEPENDENTS
736 Linswood Road, Washington, D.C.
DATE OF ARRIVAL
8-2-56
NOTE: When travel is from other than vicinity of the old station or to other than vicinity of the new station, explain circumstances on the reverse.
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GOVERNMENT TRANSPORTATION FURNISHED
KIND (Rail, air, etc. If none, so state)
PLACE OF DEPARTURE (Date)
DESTINATION (Date of arrival)
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TRAVEL COVERED BY THIS CLAIM REPRESENTS ENTIRE TRAVEL OF ALL MY DEPENDENTS ON THIS CHANGE OF STATION EXCEPT:
[illegible]
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PENALTY FOR PRESENTING FRAUDULENT CLAIM — Fine of not more than $10,000 or imprisonment for not more than 5 years or both. Title 18, U.S.C. 287; Id. 1001.
FORFEITURE OF FRAUDULENT CLAIM — Falsification of an item in an expense account works a forfeiture of the claim. Title 28, U.S.C. 2514.
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SIGN ORIGINAL ONLY
I CERTIFY that this voucher and attachments are correct and just in all respects and that payment therefor has not been received. No prior claim has been presented by me or any member of my family for the travel of dependents as claimed herein.
SIGNATURE OF PAYEE
Belbert G. Newhouse
DATE
8-3-56
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AUTHORIZED ALLOWANCE (From) Belbert G. Newhouse (To)
$ 44.00 FOR
MILEAGE
Portland, Oregon — Washington, Florida
$ 44.00
Pursuant to authority vested in me, I certify this voucher to be correct and proper for payment.
AUTHORIZED CERTIFYING OFFICER
W. F. DODDY, ACCOUNTING CLASSIFICATION: 8-3-56
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Appropriation Symbol and Subhead
17 1453.18 MPN 56
Object Class
029
Expenditure Account
76350
Chargeable Activity
22
Bureau Control Activity No.
81600
Bureau Control No.
[illegible]
Amount
$ 44.00
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PAID BY CHECK
Check number: [illegible]
Date of check: [illegible]
PAID BY CASH
Amount: $ 44.00
Date paid: [illegible]
SIGNATURE OF PAYEE (Required for cash payment only)
Belbert G. Newhouse
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DD FORM 766
REPLACES NAV. S. AND A. FORMS 252 & 913
FC-107, NAVING-177-50 & 1770-50
MEMORANDUM COPY
Form Approved by Comptroller General, U.S.
March 15, 1954
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Stamp:
AUG 6 1956
W F DODDY
SYMBOL 874102
Stamp:
NPO NEW ORLEANS
Stamp:
[illegible]
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