standard. Form No. 1012 a 
Form approved by 
Comptroller General IT. S. 
May 
Fiiblic Voucher for Eekhurseiueot of Travel and Other Expenses 
Including Per Diem 
Voucher No. 
No 
GENERAL ACCOUNTING OFFICE \ 
PREAUDIT 1 
Certified for payment in tne 
sum of $ 
J. R. McCARL, 
Comptroller General oj 
Vie United States, 
By 
■■lai. thsoni nn Inst 1, t *; % io» 
U. S 
Appropriation: 
t* 
:■ m '» 
tTatlonal 
>r Establishment) 
(Department, Bureau, or Establishment) 
\} 
THE UNITED STATES, Dr. 
To 
l>r, L. soteitt. 
PAID BY 
ISS^lOO 
(Payee) 
(For tsse of Pisylng Office) 
Official Headquarters 
(Address) 
Domicile Residence 
(For use of tHe Postal Service only) 
FOR jp| travel and oth^^expenses discharge of official doty 
from „„ K 
as per itemized statement within, under authority No. , dated , $ 
AMOUNT 
Dollars 
2ite 
Cents 
2< 
NOTATIONS 
(Payee miis! noi use lliis 
CDlHRin) 
(Additional statements by Department, 
Bureau, or Establishment, 
if deemed necessary) 
(ACCOUNTING CLASSIFICATION) 
- • ♦ m 
*0 m # # « 
O'O^O a * ♦ » 
(Payee will NOT use this space) 
Differences 
Account verified; correct for. 
(Signature or initials) 
ElSeM 
BlSe 34 
Paid by ■ 
Check No. 
_ , dated __ 
... I9.„ 
, for $ 
Ton Treasurer of the United States 
--y favor of payee named above_ 
Cash, $ 
- , on 
19, 
MEMORANDUM— DO NOT SIGN 
10— 1664s 
