/st9 
standard Form No. ,1012a— Revised 
Form Approved by 
Comptroller General, U. S. 
July 19, 1937 
General Regulations No. 88 
VOUCHER FOR PER DIEM AND/OR REIMBURSEMENT 
OF EXPENSES INCIDENT TO OFFICIAL TRAVEL 
B. 0. Vou. No. 
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) 
General Accounting Office 
y ^ Saiithso .ian 
PAID BY 
PREAUDIT 
(Department, bureau, .^stablishm^t)«. 
THE UNITED STATES, Dr., To 
Certified for payment in the 
sum of$ 
U« S . Bat • llu sQum , Wisbi ngto ni,D . 
125-100 
(Address) 
Comptroller General of 
THE United States 
Official Headquarters 
By 
Domicile _ _ Residence __ _ _ __ ___ 
(For use of Paying Office) 
(For use of Postal Service only) 
rOR PER DIEM in lieu of subsistence, mileage for personally owned motor ^g/or REIMBURSE 
of travel |t|id oft^r exp^jses paid by me in the discharge of official duty from , 
to 19_ , as per itemized statement within, under authority No. , dated 
19 , copy of which is attached,* or has been previously furnished with voucher No. , paid , 
19_ , by $ 
(Name of disbursing officer) 
(Payee will NOT use this space) 
Differences 
Account verified correct for $ 
(Signature or initials) 
AMOUNT 
Dollars 
101 
^91 
Cents 
45 
MEMORANDUM 
101*45 
ACCOUNTING CLASSIFICATION (For completion by administrative oflice) 
Appropriation, Limitation 
or Project Symbol 
1 
Appropriation Title 
Limitation or Project 
Appropriation 
Amount 
Amount 
SS90116;D01 
iT® serration or Goilsetions, 
J.UJ. * 

101*45 
$ 
£0 
hi 
* 
H 
• 
n 
Allotment Symbol 
Amount 
Encumbrance 
Liquidated 
Cost Account 
Object of Expenditure 
Symbol 
Amount 
Symbol 
Amount 
■ OflO 
■fg'.VB" 
0610 
2775 
0610 
2775 
$ 
05^ 
t mr in tT 
13.95 
0650 
S4*75 
0130 

ijest—ApL 
OBW — ■ 

-i- ^ 0 i.y 
Paid by 
Check No. 
, dated 
Cash, $ 
on 
19 
101*45 I on Treasurer of the United States 
, 19 , for $ [ in favor of payee named above. 
SIGN 
ORIGINAL 
ONLY (Signature of payee) 
*If there was no prior authority state circumstances which rendered securing prior authority impracticable. 
10— 1664a 
