standard Form No. lOlOar— 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 OFHCIAL TRAVEL 
D. 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 
PAID BY 
PREAUDIT 
(Department, bureau, or establishment) 
THE UNITED STATES, Dr., To Scstaitt 
Certified for payment in the 
(Payee) 
sum of $ 
— — - 
(Address) 
12S-1O0 
Comptroller General of 
THE United States 
Official Headquarters 
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 by me in the discharge of official duty from > 1942—, 
to 4 r 1942-—, as per itemized statement within, under authoritv No. .1 , dated , 
1942-, copy of which is attached,* or has been previously furnished with voucher No. , paid , 
(Name of disbursing officer) 
AMOUNT 
Dollars 
Cents 

aa... 
(Payee will NOT use this space) 
Differences 
Account verified correct for. $ 
S5. 
as..- 
(Signature or initials) 
MEMORANDUM 
1 
3S«8e 
ACCOUNTING CLASSIFICATION (For completion by administrative office) 
Appropriation, Limitation 
or Project Symbol 
Appropriation Title 
Limitation or Project 
Appropriation 
Amount 
Amount 
SS-19S1004 
Cooparatictn mltli ths Maricaa 
s S3,8S 
» 53.85 
— IMS 
Allotment Symbol 
\ 
Amount 
Encumbrance 
Liquidated 
Cost Account 
Object of Expenditure 
Symbol 
Amount 
Symbol 
Amount 
02 
s33.8g 
t 
o 
8 
02 
$3S*BS 
.02 
$ SSjiSS- 
Paid by 
Check No, 
, dated 
Cash, $ 
on 
1 
19 
, 19 , for $. 5 . 5 .iL 9 .& 
SIGN 
ORIGINAL 
ONLY 
I 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 
