/ 
\ 
Standard. Form ]S\>. 1012a— Revised 
. s. VOUCHER FOR PER DIEM AND/OR REIMBURSEMENT n o vo., m 
Generai»ti^«4\„.88 Qp EXPENSES INCIDENT TO OFFICIAL TRAVEL Bureau No. 
(Statement of acccunt 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) 
aaithsonian Inrst ^ 
‘^L. Schmitt, 
(Payee) 
General Accounting Office 
PREAUDIT 
Certified for payment in the 
sum of$ 
COMPTEOLLEE GeNEEAL OF 
THE United States 
By 
u. s. 
(Department, bureau, 
THE UNITED STATES, Dr., To .. ir 
UeS.Hat.Muaouia, Waaih.D»C« 
S 
• 
Official Headquarters 
Wafe1fiW|tcai,D,C, 
Domicile Residence 
(For use of Postal Service only) 
PAID BY 
125-100 
(For use of Paying Office) 
FOR PER DIEM in lieu of subsistence, mileage for personally owned motor vel^^^^gjd/o£^EIMBURSEM]^^ 
of ‘^^^'^li^Bd^ther exp^ges paid by me in the discharge of official duty from 8"" ? 
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 J 
(Name of disbursing officer) 
(Payee will NOT use this space) 
Differences 
Account verified correct for $ 
(Signature or initials). 
AMOUNT 
Dollaes 
10 
TU 
Cents 
MEMORANDUM 
10 ..,3.5: 
ACCOUNTING CLASSIFICATION (For completion by administrative office) 
Appeopriation, Limitation 
OR Project Symbol 
AppROPRLiTioN Title 
Limitation or Project 
Appropriation 
Amount 
Amount 
3300116,001 
PreSdlVatiOn of ■Collections, 
— 
$ 
$ 
1 q/if> 
— 
Allotment Symbol 
O^iO 
Amount 
rzr\ 
Encumbrance 
Liqui^ted 
Cost Account 
Object of Expenditure 
j^nount 
o6!ES”’ 

$ ID^OD 
$ 33SUO O 
0830 
$iniDo 
UQrOv/ 
D&QA 
.06 
Qf>2Q 
.05 
0690 
.06 
\JV *JXj 

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