Standard Form No. 1012a— Revised 
Form Approved by . 
Comptroller General, U. S. 
July 19, 1937 (Rev. May 15*1939) 
General Regulations No. 88 
VOUCHER FOR PER i)IE» AMD/OR RHIBURSE8IERT D 0 Vm m 
OF EXPENSES INCIDENT TO OFFICIAL TRAVEL Bureau m. 
(Statement of account mast 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 
PREAUDIT 
Certified for payment in the 
sum of $ 
Comptroller General of 
the United States 
By 
U. S jfia&aM- 
(Department, bureau, or establishment) 
THE UNITED STATES, Dr., To 
(Address) 
Official Headquarters -*****0^--*-*,. 
Domicile Residence 
(For use of Postal Service only) 
PAID BY 
1 
(For use of Paying Office) 
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 g f 19 f 
to — , 19„4©, as P er itemized statement within, under authority No. dated , 
19___4|| copy of which is attached,* or has been previously furnished ivith voucher No. , paid _ , 
19 , by $ 
(Name of disbursing officer) 
AMOUNT 
Dollars 
Cents 
mi 
-M- 
ColXaLomtor 
(Payee will NOT use this space) 
Differences 
Account verified correct for. $ 
(Signature or initials) 
ACCOUNTING CLASSIFICATION (For completion by administrative office) 
Appropriation, Limitation 
or Project Symbol 
Appropriation Title 
Limitation or Project 
Appropriation 
Amount 
Amount 
-A4UJM ... 
X mr usi Asm&iua* - 
$ Sfi3Li4 
$ SSI* SI 
JSU& mi , $f4I. 
Allotment Symbol 
Amount 
Encumbrance 
Liquidated 
Cost Account 
Object of Expenditure 
Symbol 
Amount 
Symbol 
Amount 
14X1918 
$ mm 
$ 
m 
$ m mum 

Check No. 
Cash, $ 
, dated 
on 
19 
, 19 , for $ 
SIGN 
ORIGINAL 
ONLY 
J 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 
