ML19282D342
| ML19282D342 | |
| Person / Time | |
|---|---|
| Issue date: | 06/26/1978 |
| From: | Hogdon A NRC COMMISSION (OCM) |
| To: | |
| References | |
| NUDOCS 7905310056 | |
| Download: ML19282D342 (2) | |
Text
N RC64 ia.713 U.S. NUCLEAR REGULATORY COMMISSION D'm'"ot%.UUn U,$.s.'
TRAVEL VOUCHER (Part 1)
!* 2* l3.,
. lc.s (see NRCAppendix H01for instruaionsfcr completing thisform)
(DoNotRemove Carbons) 1.
- 2. Div+ston/o f fice 3.
- 4. Address Code S. Name of Travelw (First r%O mirialf Gnd IJsf namef Code voucner No.
A,nendment a.
- o. ave oiaaa)
OHome O Ofrice
'e70 fjgpo O 5asciai 4 lEOCCCO2
(, [L(Af EY O
e___
- 6. a. Mailing Address (r.O. Sox Street or Offzer)
D. City. State
- c. Zip Coce CCM. 3=.1101, E-St:: eet Wash., D.C.
20555
- 7. Res.dence if 0.rterent from stem 6
- s. O fficial oury St.ation (City. Stsref For Traves and Otner Excenses i
'C"ttdSW. D. c.
Washe, D. c.
"' *of"ff Yd l* ' "U Y6 -la e A i
NRC TO BE BILt.EO:
- 1. N um mer Page 13. Enter le. toontification
- 15. Carrier or
- 16. Points of Travet Covered by
- 17. Moce and
- 18. Amount.. e.
acn page N o.
Aoproorlate TR No., invosco R ental Car T/R or Period of Car Rental Class of Service to be 8 lled * '
Consecutivesy.
Tsoe Code No,(see bsstruo*.
. (Name or (MM DO YY),
^
- .O&
- a. EmtnLsl ' '.y.
-W % :Qr^
Here etc.
q,'.* y T Dans).. n y
y,
?:.
Q,
,,s-u 3
7IN f.I M W
From To
'. Eacn Item
- 12. Number itern TYPE
'F CO D E.S
,1-Consecutivety I - " '. - '
T. p-.r b 4.
,B e,,g i,n.n.p.g A,TR. f
- 'N',*. L ' u..
?..
in Er%"*;
g y g:.
~
- .. c
's'"-
B=TR-
- ?.
. L one
,'6 J.
-i Way.a-C=
R ental Ca r-O.
GEBAT other E='
if more space is required for additionat nuting items use another 20 Total amount
- 19. Numoer of euung items
, Form NRC64, and complete 6tems 1 tnru S, and items 11 inru 20.
to be blHed on >
Listed on tnks Page g r
I inis page
- 21. Autnorization
- 22. Traveler's Social
- 23. For Change of Duty Stat 6cn-individuals included in tnis C1 alms No.
Car.ity No.~
,.eJUDO O Emaiovee No of Cniidrea aies tato zo.
and Parents
- 24. R and Carefuur (if woucher mctudes any of the followung, mark the appropetate boxes):
Employee and spause O voucner inciudes sna,.d Cost c(Exp1ain en Part 2.)
O 5aouse No. of Cniidren under 12 0 Consultant Travel Espenses Ctalmed
- 25. Traw havance (Ear Offlee of CONTROLLER Use)
O Abandonment of Traves ((E.xplain in Part 2.)
eaat to ne aaped O Comparative Ccst statement inciud.d 0 Leave Taken in coniunct1on wftn Trip (Explain in Part 2.)
26.(For Office of CONTROLLh I USE) Examiner's Oeduct:ons goes, gra,,s O Additionai voucners wiii ne summitted O Refun.d o.u.e.o.n.unueed Tica.t.nd/or R. fund sii.,
ie eu mu O Remettance Attached in Amt.cf S!
Hase Hunung Examined by:
Date
- 27. Actuas Time in Travel for
- 28. 5chedule No.(For Officer
- 29. Total Amount Cialmed
- 30. Total Foreyn Costs
- 31. Net to Traveler /For Offic inesuded in. tem 29 of CONTROLLER Usef Fer Diem Catculatior' of CONTROLLER Use) gy*y Days Q uarters
- 32. Certifleo Correct Payment or credit nas not been received *
,. ~.,
(Mark one 3
e y q;.-,r box for a,g e.
! y y?
any f-.
2 tions of a day) 03 (StEnature of Tra.eterf
~
(Datej
- 33. Approved. l ong distance teleonone caHs are certified as necessary
- 34. Certified Correct and Proper for P3yment in the interest of tne Government.
(Signature of.4pproving Official)'
(Datef (A uthorized Certifying Officer)
(Dare)
- 35. Accounting Class.fl cation (For Office of CONTROLLER Use):r Use):
c olect N
O bject c elect oeta n q 4. R cms L A m un*
cms c enit 9 & R Class A mount c uss Detalt e & R ctass
- c. mount c? ass A
g C
O E
p
- Fraudusent Cia 6rt--Falsification of an item in an expensg account works a forfeiture of tne claim (28 U.S.C. 2514) and may result in a f 6ne of not-more inan 310.000 or imorisonment for cot mere tnan 5 years or botn (la U.S.C. 287; id.1001).
"If Long Distance telennone esias are included, tne approving of ficer must pave oeen autnorized in writing by tne nead of tne Department or Agency to so certtry (31 U.S.C. 68ca).
7905310o(8 THIS DOCUMENT CONTAR";
P00R QUAUTY PAGES
Ef**'.Ti'F'~ ~;' ~~~
(
AND AMOUNTS Ct. AIMED
(
-Do.vorbmire car 6oris)
OEPART FROM OFFICE PACdNo. *bev/ OFFICE 10 VOUCHER NO.
Name (O AT E)
(HOUR) 1 70 00 A. EODGLON
[y[
Osv.
S U S-UNIT 06 25 78 CPM OATE NATURE OF EXPENSE AUTHORf 2EO NUMBER OF AMOUNT CLAIMED MILE AG E OF MsLES Rate C
IS
- / 8 6/'s Depart Residence via
~
tT _ S. covarnrent vehicle 5:00 o Arrive National
' 6 20 o
- ~
nepart National nr.-114 Arrive Boston-7: 28 p
.._.4..
-[
Overnight Boston S/'6 Decart 2oston via Rental Car 10:30 a fancem-nnica en - inninner Gilin + A
~
e' Arrive Mitnchester, N.H.
12:00 p
\\
Attend Oral Hearings
\\\\
nn % nwvnnte
\\
un n n k = * -,-,r4 n c r7e n n 7 n,-4.
Rental Car 6:00 p n-isr. en=*nn 7-7n 7 Depart Bor.ston 8:50 p a v,-4 ro sin
- i n.,,1 in.nn n A rive Residence 11:00ja r_ c,,,1 vv--an c o n r e n e-nn) 5,/ ' c a
ni-nor o ?g Lodging No Expense a ?r 99 's
{/2$
D a *- Mion
("swekn.=4ov b 9 ; 9
.=,t -
a,,,,*
u n n_ n _,- o_ _,- a_ n_, r
=
9 e..
Grand total ( Asnt. to De shoven in item 29. Part I)
.g g
s See Revesse of Paye, copy for privacy Act Staternent EXTRA CCPY
.