USE ONE SIDE ONLY. 
I 
*“ ' Form 4t>. 
Approved by the Comptroller of the Treasury 
May 28, 1914. 

To be completely filled in before signature by payee, 
and there must not be any erasure or 
other alteration whatever. 
Received in Cash of 
SUBVOUCHER FOR MEALS AND LODGING. 
City or Town, 
Name of Hotel, 
Date 
lliiJa&QSiJL 
U. S. DEPARTMENT OF AGRICULTURE _ 
for MEALS and LODGING from 1 .. 
— -C , inclusive. 
Time covered, i - day at $__ 2J&. — per day. 
If charge for fractional part of day is greater in 
proportion, it must be explained HEREUNDER. 
I certify the foregoing to be correct. 
No. 
/?^.i 
J-d-t-Jx 5C , 191? 
and Qd. Dollars, 
7 , 19l2„, to 
(DO NOT SIGN IN DUPLICATE.) 
(Signature) Z.ZZ:' kJ 
(Title) 
n> 
: c~t 'a»ra« v <■*- 
