ML19249A976
| ML19249A976 | |
| Person / Time | |
|---|---|
| Issue date: | 06/30/1979 |
| From: | Gilinsky V NRC COMMISSION (OCM) |
| To: | |
| References | |
| NUDOCS 7908280011 | |
| Download: ML19249A976 (2) | |
Text
'
N8CFA (5 4)
U.S. NUCLEAR REGULATORY COMMISSION Form Approved by the TR AVEL VOUCHER (Part 1)
Compimow Generai, u.$.
AC pyrendi:.1501 for instructions for completing (nm)
Mas 2. '972
(
- * (Do Not Remove Carbons)
- 5. Name of Traveler (Fsrst two snersals and last name) l.
- 2. Dives ontOttece 1.
? ;'y 4. Address Code h e '
hJ Code iaucher No.
a Amendment Scave blank) p g ] Home O Office
{
a-8.
10 70 s, 0 0
/ lOsoecid VI GILnsu
- 6. a. Mashng Address (P.O. Box, Street or Orticei
- b. City. State
- c. bp Code UCM, Room 1103, U-Strcot Uaahington, D. C.
2G555 For Travel and Other Expenses e
- 7. Resider ce it Ditterent from item 6
- 8. Off.c:al Duty Station (City, State)
- M onda, Md.
Washington, D.C.
- "'" ' N N 7 7 3 CNN9
'~
NRC TO BE RILLED:
(
- 11. Number Page 13. Enter
- 14. ider afication 11 Carrier or
- 16. Points of Travel Covered by
- 11. Mode and
- 18. Amount Each Page No.
Appropriate TR No. Invoice Rental Car TJR or Period of Car Rental Class of Service to be Bdled Consecutively Type Code No.,
(Name or (MM OD YY)
Here etc (see instruc-Initials) tions>
- 12. Number item TYPE From To
,r Each item CODES ConsecutiveJy Beginning A=TR with "1" Round Trip B=TR One Way C=
Rental 2",
Car D=
GEBAT E=
Other
- 19. Number of Bilhng items if more space is required for additional billing items, use another
- 20. Total amount Osted on this Pege L
Form NRC64, and complete items 1 thru 5, and items 11 thru 20.
to be billed on this page 3
7
- 21. Authorization
- 22. Traveler's Social
- 23. For Change of Duty Station-Individuals included in this taim:
O cmployee No. of L:hildren Ages 12 to 20.
24 Carefully (!f voucher includes any of the O Employee and Spouse wong, mark the appropriate boxes);
D "'*
er includes Shared Coat (Esplain in.. f 2. )
- 25. Travel Advance (For Office of CONTROLLER Use) 0 Consultant Travel E.xpenses Claimed 5 ' ' '.. 'r Outstandina baiance O Abandonment of Traves (expiain in eart 2.)
5-A ount to be appiied 2.~'
O Comparative Cosi Statement inciuded 5
"*'7 Balance to remain outstanding Leave Taken in Conjunction with Trip (Explain in Part 2.)
- 26. (For Office cf CONT 80LLER USE) Examiner's Deductions Local Travel Q Additional Vouchers will be Submitted O aefund ove on unused Ticuei andior Ref und Siin (E, pia,n in Pt. 2)
' Remittance Attached in Amt. of S l
S House Hunting Date Examined by:
- 27. Actual Time in Travel for
- 28. Schedule No. (For Office
- 29. Total Amount Claimed
- 30. Total Foreign t osts
- 31. Net to Traveter (for Office Per D'em Calculation of CONTROLLER Use) included in iter i 29 of CONTROLr.ER Use)
Days Quarters
$45.91
([,fy
- 32. Certified Correct Pa, ment or credit has not been sceived*
V q
say trac-I;xs of G2 e day)
(Date) 0 (Signature of Traveler)
- 33. Approved, Long distance telephone cails are certified as riscessary
- 34. Certified Correct and Proper for Pa, ment in the interest of the Government.
790828 cou (Signature of Approving Official) "
(Date)
(Authorized Certifying Officer)
(Date)
(;.
- 35. Accounting Classification (for Office of CONTROLLER Use): r Use):
4 Ob] set Object Cbiect L
Class Detail B A R Class Amount Class Detail B & R Class Amount Class Detail B & R Class Amount A
B C
Dl E
F
- Fraudulent Claim-Falsification of an item in an expense account works a forfeiture of the clair. (23 U S C. 2514) and may result in a fine of not rnore than 510.Ou0 or imprisonm*nt for not more than 5 y7ars or both (18 U.S.C. 287, id.1001).
- ll lorO Distance telephone catis are included, the approving officer rnust have been authorized in writing by the head of the Department or Agancy to so certify (31 U.S C. 680a).
SEE REVERSE OF PAYEE CCPY FOR l'RIVACY ACT STATEMENT ORIGINATlHG OFFICE COPY
TRAVELVOUCHER (PART 2i i
'*"'#" # 5 8 ' I"' #""'"'
NRC Form 64 A (5 74)
SCHEDULE OF EXPENSES
/#"'"C'fo,' completing this fann CE*o0MUnIYfu.s.
i tions
(
AtiD AMOUNTSCLAIMED
-Do Not Remore Carbons)
Mayi'ssir P
F AOM OFFICE PAGE NO.
D l'F CF ID VOUCHER NO.
Name=
MM DD YY s
1 70 00 V. GILIUSKY 6
29 79 PM AUTHORIZEO NUMBER OF AMOUNT CLAIMED DATE N ATURE OF EXPENSE MILE AG E OF MILES
~
79 Rate c
4 )O Lepart liashingnon ~(USc.) Vfa
?
/
U.S. Government vehicle 2:15 p Ju.rivu biiddlutown, Pa.
4:43 p
-1Griginally schedu1WfTi3Ht A11eghney 720 - Washington to l
iic.r.risbus.g - w r cancellec.
Il Unused porcio n f KirIrno I
ticket la returned herewith.
-6fW Tour of Tnroe Milo Island facility - attend t6W 15eidEing in !"iddletown.
6/3^*
Depart Harrisburg, AL-739 10:35 a Arrive itashingt~Dn 11230 a Depart airport via U.S.
-TJOVErDT*1t-Velifcro Arrive Residence 12:15 p j
'A s
g mum Lutusts - High Rato Area gf $45.00 per day.
a 42 40-1 6/29 notel - 442.40 3
51
-6f30-- BruaRfTst - 4 5.di 2,
t
- ~
, %l l
u
~~ <-
i
.I A
I 3_.
L d
45 al crar,d toti.t ( Amt. to be'Shown in item 2e, part 11 See Reverse of Paye. Copy for Evivacy Act Statement cp,1 gin,i,. jig CFFICG COPY 89'E 3 c/L