iSstiuidard Form No. 1012a— Revised 
Form Approved by 
Comptroller General, U. 
July 19, 1937 (Rev. May 15, 1939) 
General Regulations No. 88 
VOUCHER FOR PER DIEM AND/OR REIMBURSEMENT d o m 
OF EXPENSES ICIDENT TO OFFICIAl TRAVa 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 Accouniing OSce 
PREAUDIT 
Certified for payment in the 
sum of $ 
Comptroller General of 
THE United States 
By 
(Department, bureau, or establishment) 
THE UNITED STATES, Dr,, To . 
(Payee) 

(Address) 
Official Headquarters 
Domicile Residence 
(For use of Postal Service only) 
PAID BY 
125-100 
(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 by me in the discharge of official duty from , 19-llk_, 
to , , as per itemized statement within, under authority No.? , dated , 
19. 4L ., copy of which is attached,* or has been previously furnished v/ith voucher No. , paid , 
19 , by ^ 
(Name of disbursing officer) 
(Payee will NOT us© this space) 
Differences ^ 

Account verified correct for_ $ i 
AMOUNT 
Dollars 
42 
Cents 
81 
A> 
(Signature or initials). 
42 .a 
MEMORANDUM 
x\CCOUNTING CLASSIFICATION (For completion by administrative office) 
Appropriation, Limitation 
OR Project Symbol 
333O0LU«Oai 
Paid 
Appropriation Title 
fre@eryati(m of OeUaeticH^ 
Limitation or Project 
Amount 
$ 
Appropriation 
Amount 
$ 
Allotment Symbol 
Amount 
Encumbrance 
Liquidated 
Cost Account 
Object of 
Expenditure 
Symbol 
Amount 
Symbol 
Amount 
— 
oa — 
~MJEl 
BO.OO“T 
^kSUSk 
03 
• 
V > 
— 
Check No 
Cash, $ , on 
., dated 19 
, 19-- 
., for $ 
SIGN 
ORIGINAL 
ONLY 
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 
