ML19291A733
| ML19291A733 | |
| Person / Time | |
|---|---|
| Issue date: | 07/10/1978 |
| From: | Eysymontt G NRC COMMISSION (OCM) |
| To: | |
| References | |
| NUDOCS 7905240735 | |
| Download: ML19291A733 (2) | |
Text
Form AppowNl by t.*5e c,mpue.e seneras, u.s.
f TH AVE L VOUCHER (Part 1) f-sesy 2.19'2'.
(SQ W Appendix 1501 for instructions for enmpleting.S 3rm)
(Do.\\ot Remove Carbons)
~
Q t.
- 2. Dives onl of fice 3.
- a. ACd'est Coce
- 5. home os Traveter (Farse swo mes.ars and sast riame)
Code vouct:or No.
N, Am adtrent peave WanM k OHome G =
J e
3, g
Mg fat 0o k 05-=>
cllzvsnc:rrr Giumsgv O
"'7o 5
G. a. Ma.8+ng Ad1resa (P.O. Das, street or Ott,a)
- n. C.ty. Stato
- c. 24p Code Oct, noca 1103, U-Street i!ashinoton, D. C.
20555 T.
moonee if 0.sterent from item 6
- 8. Official Outy Stat on (Ory, State)
For iravet and Other Espenses (C,ry. J' ate)
- 9. From (MM 00 YYi l 10. To: (MM OD YY)
Cauvy Chase, Md.
Wash hqton, D. C.
07/08/73 1
07/10/73 NRC TO BE BILt.ED:
- 11. Nurnoer Paga 13. Enter
- 84. Identification
- 15. Carreer or
- 16. Points of Travel Covered by
- 17. Mode and
- 18. Amount Easta Page No.
Approcriate TR No., invo.co Rental Car TIR or Penod of Car Rental Class of Service to be Balled
_Consecutwgey Type Code No..
(Name or (MM 00 YY) r etc (see s,astrue.
Anersais) 1 lHere
- 12. Peumcer item TYP5 From To
' n.,
r, y
Facn stem COCES Consacu,twoly 8,,m. y A. TR won r Round Tng Oe.TR Om
"'a' THIS DOCUMENT CONTAINS E"aia POOR QUA JTY PAGES Car De GEBAT Em Other
- 19. Number of eiilmg items tf rnore soace is required for additional tullirj stems. use another
- 20. Total amount Listed on tNs Page A
Form NRC64. and complete items 1 thru 5, and items 11 thru 20.
to be belled on V
this pace
- 21. Authorization
- 22. Traveler's Social
- 23. For Change of Duty Station-Individuals included in this Claim *-
No.
SacurityJ40 3JJ00 C
1 O Empioree No. of Cmidten Ages i2 io 2a.
and Parents
- 24. Read Care uity (If voucrer lnesudes a*ty of sne Q Employee and Spouse r
toHo, co. mark Ine appropriate boxes):
~
O vouct er inciudes Shared Ccst (E,, fain in eart 2.)
O 5poua*
No. o' Cn;idrea under i2 O Consuiiani Traves E=neases Ciaimed E. Trave' Advance (For Ott<ce of CcNrRottER Use)~~
5 Abandonment of Travel (Erstain in Part 2.)
Outstandin2 balance 5
O Comparativa Cosi statemeat inciueed Amouai io de spatied 0 teave T=*ea ia Conior<tioa -ith Trip (erosa.n in rare 2.)
saiaace io remaia outsinacian 5
- 25. (For Ottsee of CON TROLLER USE) Examiner's Deductions O Local Traves Q Additenal Youchers will be Submitted 5
O ae'uad cue ua unu.ed Tieset and,or R.f und Siip (e,, rain in er. 2)
O Remi" ara Aitached ta ^=t. of
- I I
Q House Hanting E=amined by-Date
- 27. Actual Time in Travet for
- 23. Schedute No. (For Office
- 29. Total Amount Claimed
- 30. Total Foreign Costs
- 31. Net 13 Traveler (For 01/1 Per Deem Ca;culatson of CONTROLLER Use)
Included in item 29 of CONTROLLER Use)
Days O.;arters 41A a4 d'
f g3 J2. Cerblied Correct Payment or credit has not twen received-any trac =
rions of 2
s day)
(Signature of Traveler)
(Date)
- 33. Aoyovad. LonC distance tesechone calls are certified as necessary
- 34. Certif ed Correct and Prerer for Payment in tne interest of the Government.'
(S yature of Appro. ring Official) '
(Date)
(Autneriz=d Cert >fying Othcer)
( 0 110)
- 35. Acccunting Classifiestion (For Ott,ce of CONT. TOLLER Use): r Use):
~
Object I
a Object ObPet Class Data.1 l B & R Class l Arrount Civ.
D=t ail B & R C! ass Amount Class Detail B & R C!ns Amount A
B C
D E
F Frawdw en: cia m-Fr.s.t. cat.on of an item en an esans, account worits a for'e;ture of t. - dm ( 3 U S.C 2514 and reay result i;i a tene of not more than SQ.Cr.o or e
impnsortment for not inore inan ? years or both (t$ U 3.C. 237; io.1001).
"If Long D va ce ;e-epPone cabs are inc*udest, the approving officer trust r ave tees aeer$~d b,2 4 6. by tP:e ha d of the D+partm writin n
(i 7 73g (3i u s.C. uca).
- re r>svEase Oc ?.tYEE COPY FOR PRIVACY ACT STATEstENT EXTRA Co?Y
ve,m A,oi.a c.a 011ne SCHEDULE OF EXPENSES (See NRC<1ppendix 13,01 forinstrue sareve oi n
. U.s.
,f,,,, p,,,,,,pf, f,,,,w, p,,,)
cp%"1[
AND AMOUNTS CLAIMED
-Do Not Reinore Carbons PAGE NO.
Osv/ OFFICE ID VOUCHER NO.
Name DEPART FROM OFFICE DIV.
Su fs-U NIT (D
E)
(HOUR)
OAM 1
70 00 G. EYSYMONTT 7
8 78 PM DATE NATURE OF EXPENSE AUTHORIZED NUMBER OF AMOUNT CLAIMEO MILEAGE OF MILE.S 19 Rate
(
UU
' Depart Residence 1:00 p arri.n navienni Depart National PI-901 2:40 p, arriva NnvFn1V 3r40 p Navv transoortation from Airport to stibmarine USS MEMPHIS 7/S nepart Morfolk. Va. aboard USS MEMPHIS
-5:00 p 7/1tl nrvivn charleston. South Carolina 11:'. 3 p nepart Ship 12:30 o
'Pnne of charleston Naval Base 7/14 nepnet charleston NA-414 7:00 p Arrive Untional 8:08 p nrrivo nanidenen 9:00 o I
ACTUAL EXPENSES Uardroon Messbill (nncoiph M knched) 7 70 r.tTecer.T.Arn'ntin nen nTry EXPENSES 2-1/2 days at S3.50 per day 8 75 y
16 45 c,.no not : same. to n. sno n i,, ii.m 2,;,,, ::