Standard. Form No. 1012 o 
Eonn approved by 
Comptroller General U. S. 
May 3, 1929 
Public Voucher for Reimbtsrsement of Travel and Other Expenses 
Including Per Diem — Continuation Sheet 
Payee 
Dr. Mh 
D 
Ik' 
ITEMIZED SCHEDULE OF TRAVEL AND OTHER EXPENSES 
19 
ATE 
i 
CHARACTER OF EXPENDITURE 
(To be itemized by the day and fully explained) 
SUB. 
\fOU- 
AMOUNT 
NOTATIONS 
J|0_ 
NO. 
SUBSISTENCE 
OTHER 
(Payee must ac t use 
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