ML19249A974
| ML19249A974 | |
| Person / Time | |
|---|---|
| Issue date: | 07/19/1979 |
| From: | Gilinsky V NRC COMMISSION (OCM) |
| To: | |
| References | |
| NUDOCS 7908280009 | |
| Download: ML19249A974 (2) | |
Text
.
,/
N4fp,#'I U.S. NUCLEAR REGULATORY COMMISSION ed by the Comptron., ceneral. U.S.
TH L VOUCHER (Part 1)
(f
.lC AppenJsz 1$U instructioas for wmpleting sm)
May 2,1912 v
(Do Not Remove Carbons)
- 5. Narra of Traveler (Farst two initiars and last riarrie) s;4. Addresa code 4,
11.
- 2. OmniontOft.ce 3.
p' ' ' QHome O office
(-
cMa Voucher No, A
/ (leave blank) y Amendment 7 ',
B.
I, O
"70 b*t 00 bdOSpecw V lGILIUSKY
- c. Zip Code
- 6. a. Mainng A'.tdress (P.O. Box Street or Ottace)
D. City. State OCli, EcoA110 3_,_ li-Stree t Washington, D. C.
20555 7
For Traves and Other En,ensee
- 7. Resedence of Datterent from item 6
- 8. Othcial Duty Station (City, State)
- 10. To $MM 00 Yvb r
W
- 9. From (MM Op/7)9 0 /26/7
+
(City State) 03/23 Bethesda, Md.
Washington, D. C.
NRC TO BE BILLED:
~
- 17. Mode and 18 Amount
- 11. Number Page 13. Enter
- 14. Identification
- 15. Carrier or
- 16. Puents of Travon Ccvered by Each Page No.
Appropriate TR No. Invoice Rental Car TIR or Perlod of Car Rental Class of Service to be Billed unsecutively Type Code No..
(Name or (MM 00 YY)
Here etc (see instruc-Initials) 1 tronn T
- 12. Number w TYPE Y
Each item CODES
{
Consecutively Becmnmg A=TK with "1" Round Trip B=TH One Way Y
C=
Rental Car D=
GEBAT E3 Other
- 20. Totr/ amount
- 19. Number of Banhng itemi If more space 6s required for additional bming items, use another Usted on this Pece Form NRC64, and complete iterns 1 thri 5. and items 11 thru 20.
be b ad on g
- 21. Authorization /
- 22. Travfler's Social
- 23. For Changs of Duty StatKm-individuats incfuded in this Claim:
No.
Secuoty No.
9.U00 3.33-26-8067 O Ernployee No. of Chudren Ages 12 to 20.
and Parents
\\d Carefully (It voucher includes any of the E'"D'*Y** ""0 090*'*
24
%ce";, mark the uppmpriate tm**Y
'"d'*" '" ur i 2 O 8""
O voucher includeo Shared Casi (Esaiaia o Part 2.)
- 25. Trave 6 Advance For Ott#ce of CONT 60LLER Use)
Consultant Travel Expensee Claimed 5
" 'n Outstandmg baiance C Aband-mat of Travei (Exciaen in Part 2.)
5 o 'm Amount to be appii d O Comparative Cost Statement inciudad S
W_%
Balance to remain outstanding Leave Taken in Conjunction win Trip (Frplam in Part 2 )
- 28. (For Ort,c. of Cou> Rotter USE) Exam.ner s Deeuc. ions O 'ocai Trave,
] Addit!onal Vouchers wiH be Submitted S
Q Ref und Due on Unused Ticket and/or Ref und Siip (Explain in Pt. 2)
Pemittance Attached in Amt. of $
k " # 1Date D h " ' 1 1 O House Hunting I s -) G, tH e rir.00
^
/
exammed br
- 27. Actual Time in Travel for j 23. schedute tk (Ior Office
- 29. Total Amount Claimed
- 30. Total Foreign Costs
- 31. Net td T'raveler (For Ottice included in item 29 of CONTROLLER Use)
Per Diem Calculat,on s of CONTROLLER Use)
Days Quarters
- 2. Ceriined%7ect Payment or crsdit has not been rece4ved*.
[
rk"*
O,
4 jj j
any trac.
?,
/
7/$/7}
, y O
(Signature of Traveler)l (Date) / /
- 33. Approved, Long distance toiephone calls are certified as necessary
- 34. Certified Correct and Proper for Payment
(
UE tn the intereat of the Government; y't 90828 ews i
/
i h
f
- // - l-j r j (Date)
(Da te (Authorized Certitymg Otticer) (Sr;, nature of Approving Otticial) " L
- 35. Account ng' Classsfication (For Ottice of CONTPOLLER U.a): r U,e):
Otuact l Object Obixt Crass Detaa B & R Class i Amount Class Det4I B & R Class Amount Class Det ail B & R Class Amcunt B C )) jp
- p
- y,.t.
(") F a D l E
- Freud 7ent claim-Fals hcanon of an item in an eoense account works a forfeiture of the claim (28 U.S.C. 2514) and may resuit in a fine of not more than $10.000 or impr.mnment for not more than 5 ye rs or buth (18 U S C 237, id.1001).
d of the Depstment or Agency to so cerhty
- 1f Long Distance telephone cans are inc!vded the approving othcer crest have bean authorized t*. writino by the hea (31 U.S C. 680a) jQ G Lj' L 3
PAYEE COPY SEE REVkRSE OF PAYEE COPY FC 4 PRIVACV ACT STATEMENT h
~ ~ ' ' TR AVELVOUCHER (PART 2) IS"',i,#((["Illgff[][,1l',"[ll,$ t4HC rorm 64 A (5 i6) ('S;7[*cNT.I.*u.S. SCHEDULE OF EXPENSES . /, t.ND AMOUNTS CLAIMED -Do Not Remote carbons / P F T FROM OFFt F Acc NO. Div/OFricE io v0VCHER NO. 'N.,me 0:V. SUB-UNIT MM 00 YV AM ,f = 70 00 V. GILEISKY 3 25 79 g,, DATE NATURE OF EXPENSE AU THO R I ZEO NUMBER OF AMOUNT CLAIMED MILEAGE OF MILES i Rate 4 .j 19 1 Travel scheduled from hashington, D. C. to Forfelt Virgini' anheturn_was_.- cancelled. Unused airline ticket is returnnd herewith. L r_' k -m-i. m. i I f ,i 4 e L 'q l Grand totti ( Amt. to be Shown in item 23. Part I) see Revers. o' Payee copy for Privacy Act Statement PAYEE COPY}}