ML19282D070
| ML19282D070 | |
| Person / Time | |
|---|---|
| Issue date: | 10/26/1978 |
| From: | Eysymontt G NRC COMMISSION (OCM) |
| To: | |
| References | |
| NUDOCS 7905110189 | |
| Download: ML19282D070 (2) | |
Text
-
NApQedNine U.S. NUCLEAR REGULATORY COMMISSION TR AVEL VOUCHER (Part 1)
.f Contra.w c:aneral. U.S...
1 M
Ma1 2. 1372 '
lS K'Appendi.r 130f farinstructions for completing Q xm)
(Do Not Ren ove Carbons)
- 2. Cms on#Cibco 3.
- 4. Acc'es* Code
- 5. Name of Traveier (First two,mtises and fast namet.
..,3 tN*Odl.
Code voucher No.
Q Amendment (teave blan4
[Home O orr~.c=
(
5,?,0 0 Ospecias Gl EYSYMOFIT b ILlMJW/
g, dO
~70 f
y
- b. C.ty. Stace
- c. zao Coce
- s. a. usa.ng Acca e sr.o. saa, street or oltree)
Rocm,1103, GCMr E-Street Washincton, D. C.
20555 For Traves and Other E.zpenses
- 7. Remcence it Ostforent from item e
- 8. Otticial Duty Staban (Gry, state) lbMM 00 YY)/26/78
- 9. From (/21/78 - -
l 10. To:
MM DO YY)
(Cry. State) 10 Chevy C%se, Md.
Was W atone D. C.
NRC TO BE BILLEO:
i t. NurnDer.
Page 13. Enter.
ta. Identification
- 15. Carrier or
- 16. Po.nts of Trevel Covered by
- 17. Mode and
- 18. Amount E.ach Psco No.
Acoroortate TR No., Invo.co Rental Car -
TIR or Perood of Car Rentai Cass of Serwce to be Billed.
Coneschtsv"'y Type Caos No (Name or tMM 00 YY)
. - f.
Here initsesa) 2.'s US,
> 1 ets.(see instruc-
- e.. -
t,on t.
- 12. Number item TYPE From To y
Ezn item CCCES Consecub,ely g
A =TR seo n.n.,en..
Trip =-
B = TR one ar THIS DOCUMENT CONTUNS b.,
POOR quAUTY P, AGE 3-
.J y
D=
GEBAT Em Other
- 19. Numtwir of Osibng items if rnore space is required for additional twiling items, use another
- 20. Total amount Listed on thes Page A
Form NRC64, and Cornplete items 1 thru S, and items 11 thru 20.
to be billed on F,
this pace
- 21. Autnortzation
- 22. Trave 6er's Social
- 23. For Change of Duty Station-Individuals included in tries Clairrr.
No.
Security No.
%D00 -
F-O Employee No. of Chitdren Ages 12 to 20.
- 0 P '****
- 26. Read Carelunly (It voucher lectodes any of the E"9'*1** # SE****
r foHo. wang. rnarer the apprognate bones):
Vouchar includes Shared Cost (Erpteln in Part 2.)
O 55ou's o' Ch"dren unde,12
- 25. Travet Advance (For ott,ce of CONTROLLER Use)
Consultant Travel E.spenses Caimed 5
O Aba-doameat ce Tr=vei (Esaiain in part 2.)
outstaadian baiaace L% c '
Amount to be appiiod
-r" O Comparative Cost Stainmeai inciudad S
r*rs nes Balance to rernain outstandmg Leave Taken in conjuncthan with Trip (Espla,n in Part 2.)
gne,g g,.,,,g
- 26. (For Othee of CONTROLLER USE) Esamsner's Deductiona Q Additional Vouchers will be Submitted Refund Due on Unused 11cket andta Refund $11p (Esplain in Pt. 2)
O nemiitance Attached in Amt. as s 1
I O House Hunting
~
d".kCate Examined by"
/ -/ 6 /n f
- 27. Aduaa Time in Travel for
- 25. Scnedule No. (For Othce
- 29. Total Amount %ed
- 30. Total Fore,gn Costs 31/ Net to Traveler (For Office Per OleoCalculanon et CONTROLLER Use) included in itern 29 of CONTROLLER Use)
Days Quarters
$371_dO 3,.n
,,8"'
32 Cartitied Correct Payment or credit has not been received *,
9 any troo--
t>0ns of 0%
10 /9*7 /~7 R a day) 0' (Signature of Traveler)
EDate)"
- 33. Approved, t.ntig distance teleonone calls are certatied as nar=== =ry
- 34. Certified Correct and Proper for Payment -
la tne inter =4 of the Govemment.
,.z, ;
caurnodred Certifying orneer)
(Dare)
'(MIMt Jf s'* Com-11SS1,%'kgr
- 35. Acr untmg Cass.ticasson (For O!!ce of CONTROLLER Use): r Usa):
Chiact Cbrect Cbiect -
C: ass Dat ail B & R Class Amount Class Det ail B & R Class Amount C: ass Det i B & R Case Ames,nt 2i
/A h ? /?)Ao' Y/$l)
O E
F
- Frau.1uient Caim-Fals hcation of an item in an eromse account worais a forfe,ture of the cia.m (23 USC. 2514) and may result in a fine of not nwe than sto. COO cr imprisonment for not more snan 5 years or botn (18 U.S.C. 237; id.1001).
"If '.amg Distance troephone calls are included, the apptwing otbcer must have ba.en authomed in uvnting by the read of the Departmeat or Agency *o so certHy (38 L' S.C. f.,aual 7905110/S'/
t
< * ~ * * ~ ~ ~ ~ ~ = * ~ ' - - - - -
ssursa jur sumpue s song ems purore s.amotroteer uanstal. u.1 AND AMOUNTS CLAIMED
(.
(,.,
-Do por R<more Cuboas) i DEPART FROM OFFICE P AGE,N O.
Qiv/OFF'CE 80 VOUCHER NO.
Name (O ATE)
(H Ot#R)
Olv.
Su s.UN eT MM 00 YY AM 1
70 00 G EYSYMON';T, 10 21 78 PM OATE NATURE OF EXPENSE AUTMO R t 2EO NUMBER OF AMOUNT CLAIMED MILEAGE OF MILES Rate _ 7_ C
^
)g 10/21 Depart Residence via private 11:00 a 210 35 7 0,,
owned vehicle 3
Arrive New York, N.Y.
4:00 p 2.. r. u.,:
7 10/2.1-Attend AIF Coziterence on 4,
- 7' '
l 10/ 23 Nuclear Nonproliferation
<.-x,J..
and Saieguards 4.,..
l New York Hilton
~
l 4
Registration Fee (Receipt Attached) 250 00f (No cleals were included) 10/26 Annual Leave 10/2'6 Decart New York via trivate 11:30 a owned vehicle 210 35 70.
Arrive Residence 4:30 o i,
s..- n.-
j Mo personal' expenses -
incurredd'shile in l
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6
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Grand total (Amt. to tie Sho n in stem 29, part I)
(
321 40 f
l See Reverse of Payee copy for Privacy Act statement PAYEE COP'
.