STATEMENT OF TRAVEL PERFORMED FOR WHICH REIMBURSEMENT IS NOT CLAIMED 
BY TRAVELER 
DATE OF 
TEAVEL 
^^42- 
8 
8 
NO. OF TRANS- 
PORTATION 
REQUEST OR 
SPEEDOMETER 
READING 
S1«S,265 
stmz,zm 
FROM— 
?lashiagtOB^ D#C* 
Miami, Fla# 
TO— 
VIA 
(Kind of carrier 
or vehicle)* 
Fla* & returzi E.A>L* 
Balboa. C«Z. & rettun P.A«A* 
CLASS OR 
MILEAQEt 
Ist 
1st 
AMOUNT 
1101 #22 
216#00 
* *Railroad, steamship, airplane, bus, etc. ^ .x- - 
tAbbreviate class of service or accommodations used. Railroad; F, first class; I, intermediate class; M, mixed class; C, coach; P, Pullman accommodations; DR, drawing room, 
OP compartment; BR, bedroom; SOS, single occupancy section; SEC, section; LB, lower berth; UB, upper berth; S, seat. By other mode: Number of miles traveled. 
INSTRUCTIONS 
1. The provisions of the travel regulations must be strictly observed in order to avoid suspensions and disallowances in '^e accounts. 
2. When more space is required for itemization of the account, use continuation sheets (standard forms 1012b— Revised and 
1012c — Revised) and fasten together in upper left-hand corner. ^ i . . . . • 
3. As many copies of the approved memorandum voucher may be made as required for administrative purposes. 
a, 8. aOVEENSIENT FRENTiNa OFFICE 
10— 1664a 
