ACCOUNT OF 
A. ZAPPONE. 
DitSuMaiNQ Cunt, 
MAIL THU ACCOUNT 
FOR SETTLEMENT 
DIRECT TO YOUR 
BUREAU. 
T>ept. l-’orra No. 4. 
Approved by the Comptroller of the Treasury May 2*., 1914. 
U. S. DEPARTMENT OF AGRICULTURE. 
STATES RELATIONS SERVICE. 
Voucher No. 
Official Station, 
Temporary Station, 
PUBLIC VOUCHER FOR REIMBURSEMENT OF TRAVELING, STATION, AND FIELD 
EXPENSES, AND FOR PAYMENT OF PER DIEM. 
APPROPRIATION: 
The United States, 
SYMBOL. - 
To 
M-L UM. 
>V£LiC 
, Dr. 
Address: 
Bureau No. 
The aubmiasion of accounta on this form without consulting inatructiona on the back hereof may delay payment. 
AMOUNT. 
For REIMBURSEMENT of traveling, station, and field expenses, and for payment 
of per diem allowance, as per itemized statement herein set forth, incurred in the 
discharge of official duty from , 191 , 
to , 191 , under written authorization from the 
Secretary of Agriculture, No , dated , 191 , 
a copy of which is on file in the Treasury Department. 
Amount claimed 
Payee mu.it 
not use this 
column. 
Dollar.*?. Cents. Notations. 
(Bill must be completely filled in by payee before certification, and there must not be any erasure or other alteration whatever.) 
Examined 
by— 
ss: 
I DO SOLEMNLY SWEAR that the above account and statement annexed are just and true in all respects at? verified by a memorandum 
kept by me; that the expense waa necessary for the proper performance of the public business; that the distances as charged have been actually 
and necessarily traveled on the dates therein specified; that the amounts as charged have been actually paid by mo for traveling, station, and 
field expenses; that no part of the account has been paid by the United States, but the full amount is justly due; that all expenditures included 
in said account other than my own personal traveling expenses were made under urgent and unforeseen public necessity, and that it was not, 
for the reasons stated herein, feasible to have payment made for such expenditure by the Disbursing Clerk of the Department of Agriculture. 
So help mb God. 
Sign 
here 
(Signature.) 
BUREAU L. A. No. 
Subscribed and sworn to before me at this day of , 19 
(Official title.) 
I certify that the sendees have been performed and the expenses incurred as stated in the above account, except as noted; that they were 
necessary and proper; that the annexed statement has been examined, and that the amounts paid were just and reasonable, except as noted. 
Qjit*. 
Amount claimed. $ 
Differences as within noted, •? .... 
(Signature.)... ... 
Approved for f 
mm> wm urn , r* . 
vfcf/h j Chitff Aoiop n a 1 
above. 
Paid by check No. i. — , dated ... 19 2D , on the Treasurer of the United States, in favor of payee named 
re. I s—*>4» 
t 
