BILL TO 
:*n€;14L 
TRAVELER: show on reverse actual 
SERVICE RENDERED IF DIFFERENT THAN 
REQUESTED 
n Ql 
vj 
E D, Cl 
J- 
fk ET i‘ ) | 
I’. mk[ 
(IF ROUND TRIP SERVICE REQUIRED WRITE "AMD RETURN") (SHOW CARRIERS AND JUNCTION POlwfsAflD WHERE MIXED CLASS' SERVICE IS TO BE FURI 
m m m ** mm <«# ** ** am **» *«* w *# ** «• *»'■<** ^ m- #» *mmm 
W8hhi 
SPECIFY 
Uif& 
_ 
m 
Tif 
%9 
»4fmw m- ***• *m *m m* °m #m 
■ ^w&rjLAtae--—_—— -— 
: . '’Wr 
(LOWER BERTH, P. C. SEAT, ETC.) 
'*ax ***** ** m m #** MPK **r m *'# afm m *m -■»#' 
m mm m mm* m* mmm *m m «**m vmm 
m m m* 
(IF ROUND TRIP SERVICE REQUIRED WRITE "AND RETURN 77 ) 
, mmmmmmmmmm __ <m, -y* m m m m m m «# m 
J CERTIFY THAT I HAVE RECEIVED THE TRANSPORTATION SERVICE OR TICKETS REQUESTED 
EXCEPT AS STATED ON REVERSE SIDE , 
jf- 
TRAVELER’S 
SIGNATURE 
TITLE 
His, Agmt 
# W- « 
PLACE OF # 
issue It f 7 ”* 1/1 
® 1* ,. ^! . fel lJ|| r#_ _J 
—..- -g.—.r ,; S‘ rms#* &*&■ ^ . - .y 4 
I CERTIFY THAT THE TRANSPORTATION ^REQUESTED IS 
BUSINESS . 
V.' 
TRAVELER MUST ASCERTAIN COST OF TRANSPORTATION AND/OR 
ACCOMMODATIONS AND RECORD IN SPACES BELOW 
o2 . €^%J 
TRANSPORTATION AMT. 
ACCOMMODATION AMT. 
TOTAL 
ISSUING OFFICER’S 
SIGNATURE 
**fi n* 
TITLE 
Travel 
FISCAL DATA ( APPROPRIATION, AUTHORIZATION, ETC.) 
1 A 
**»• SmM 
jUB&tJjM 
TICKET AGENT WILL NOT ACCEPT THIS 
'Vk.ii •. 
dated Jituii 
150330-3370 
1 M "S *S 
•y* .j 
4 
:** 
^ '1 
m 
