Standa-rd Form No. 1012ar- Revised 
Form Approved by 
Comptroller General, XJ. S. 
July 19, 1937 
General Regulations No. 88 
VOUCHER FOR PER DIEM AND/OR REIMBURSEMENT n o vo. m 
OF EXPENSES INCIDENT TO OFHCIAL TRAVEL Bureau No 
(Statement of account must h& 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 
U. S. ^nithsooiaa la^titution^ U.S. Hatioiml Masem 
PAID BY 
PREAUDIT 
(Department, bureau, or establishment) 
THE UNITED STATES, Dr., To 
Certified for payment in the 
(Payee) 
sum of $ 

(Address) 
126-100 
Comptroller General of 
THE United States 
Official Headquarters l&sMagfcan,..BjtG..- 
By 
Domicile Residence __ 
(For use of Paying Office) 
(For use of Postal Service only) 
FOR PER DIEM in lieu of subsistence, mileage for personally owned motor vehicle, and/or REIMBURSEMENT 
of travel and other expenses paid bv me in the discharge of official duty from Jtm® -t— , 19.42., 
to -liftly.A. , 1942.., as per itemized statement within, under authority No. — dated _ , 
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 
AMOUNT 
Dollars 
Cents 
Account verified correct for. _$ 
(Signature or initials) 
MEMORANDUM 
136.66 
ACCOUNTING CLASSIFICATION (For completion by administrative office) 
Appropriation, Limitation 
OR Project Symbol 
Appropriation Title 
Limitation or Project 
Appropriation 
Amount 
Amount 
.....25-1021004 
GaapBmfcijaax.--3i.tli-.th0-.. 
lL^ubli.cS-..(jfcransi!ar.-.te 
liaariem 
S1S6-6S 
ass. 66 
-r— --- 
Allotment Symbol 
Amount 
Encumbrance 
Liquidated 
Cost Account 
Object of Expenditure 
Symbol 
Amount 
Symbol 
Amount 
-02 
tis.€.*.as 
m 
as 
0? 
- 
' Check No. 
Paid by < 
. Cash, $ 
, dated 
on 
19 
, 19 , for $156 jiS5 
SIGN 
ORIGINAL 
ONLY 
1 on Treasurer of the United States 
[ in favor of payee named above. 
(Signature of payee) 
*If there was no prior authority state circumstances which rendered securing prior authority impracticable. 
10— 1664a 
