ML19309H954

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Travel Voucher for V Gilinsky on 800304
ML19309H954
Person / Time
Issue date: 03/31/1980
From: Gilinsky V
NRC COMMISSION (OCM)
To:
References
NUDOCS 8005200705
Download: ML19309H954 (2)
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U.S. NUCLEAR REGULATORY COMMISSION

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g n 0,.5, 2 0 010 TR AVEL VOUCHER (Part 11 Compt.aer Gener3. u.s.

May 2.1972 (St...M Appendix 1501 for instruct ons for completing s ;;. sm) e,

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(Do hot Remove Carbons)

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h* h. t.ddrest Code S. Name of Traveler (F#rst two c.ettis and test namel.

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2. OmseontOffee 3.

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. Amendment r

Code Voucher No.

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v.wOsom* G o" ace UW O

"'70 if,*t 0 0 MOSoeciai vl l oILInsgy S

6. a. Masi.ng Address (P.O. Sor, Street or Ortsce)-
c. C4ty, State
c. Zip Code UM EC, l_717 H St., mi, E-1103 Washington, DC 20555
7. Res.dence if Detterent from item 6
8. Offcial Duty Station (City, State)

For Travel and Other Expenses bCity SYte) da, HD Washington, DC 03 04 80 l 10. To:03 04 80

9. From (MM DD YY)

(MM 00 YY) etnes NRC TO BE BILLED:

1 t. Number Page 13. Enter.

14. adentitcation
15. Carrier or
16. Pomts of Travel Covered by
17. Mode and
18. Amount Each Paos No.

A into TR No., invoice Rental Car TsR or Period of Car Rental Class of Service to be Bahed Consecutively Type No.,

(Name or (MM DD YY)

Here etc (see instrue.

Instrats) k 1

tsons)

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12. Number item TYPE

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y From To Each item CODES Consecutively A. Tn w &mning v

Round j~

Trip B. Tn One

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THIS DOCUMENT CONTMNS C.

gi' POOR QL AUTY PAGES D.

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GEBAT' E.

Other

19. Number of Ballmg items if more space is required for additional billing items, use another
20. Tusal amount Lisied on this Paos L

Form NRC64, and mmplete items 1 thru 5, and items 11 thru 20.

to be billed on F.

this page

21. AuthortzatiorV
22. Traveler's Social /
23. For Change of Duty Station-try.Mduals included in this Qaim:

V-No.

Security No.

OAS00 133-26-8067 g g,,loy,e so.,, Chi >dren Ages.12 to 20.

and Parents

24. Read Caretutly (It voucher includes any of the

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fotoowong. marit the appropriate bones):

Voucher includes Shared Cost (EmplaJn in Part 2.)

O Spouac No. of Children Under 12 Consultant Trevel Expensee Qa6med

25. Trani Advance (For Ortsce of CONTROLLER Use)

C Abandonment of Travel (Emplain in Parf 2.)

Outstandmg balance I

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OZ,00 0 Comparet ve Cost Statem=nt iac5uded

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.MC i-Leave Taken in Conjunction with Trip (Explain in Part 2.).

Balance to remaun outstanding

26. (For Othee CONTROLLFR USE) Examiner's Deduction: ~~

300,CC Local Travel, e. -

ud,honai vouu,s enn be Sub-med

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Ref und Due on Unused T)ctist and/or Refund $4ip (kaplam in Pt. 2) i I

Q Romittar:ce Attached in Amt. of S J

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27. Actu1 Time in Trevel for
28. Schedule No. (For Ottice
29. Total Amount Claimed 30! Total Foreign Costs
31. Nei to Traveier (For Othee Per Deem Ca6culation of CONTROLLER Use)

O* *M [ n n'/'

Included in item 29 of CONTROLLER Use)

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Days ' Ouarters F

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22. Coriafaed Co,,

es,,nen, o,,c,ed., has, sot oceived.

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any trec.

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tions of O2

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33. Aporovert. Long distance telephone pils are certified as,necessary,,.

34 Certified Correct and Proper for Payment

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In the tptereneof the Government.

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V &&Ne o!W biscletV'

4CNte).lOU (Authorized Certifying Ottocer)

(Dete)

35. Acmunting dassification (For Ottoce of CONTROLLER Use): r Use):

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Object Obtect Ciass Detail B & R Class Arnount Class Detall-.

B & R Class.

Amount Class Detall B & R Class Amount

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  • Fraudulen Cla*m-Falsification of an item in an expense account works a forfeiture of the claim (28 U S.C. 2514) and may result in a fme of not more thar* 410.000 or imprisonment for not more than 5 years or both (18 U.S.C. 287; la.1001).

"If Long D. stance telephone calls are included, the approvmg off cor must have been authorized 6n writing by the head of the Department or Agency to so certify Q1 U.S.C. 680s).

SEE BEVERSE OF PAYEF COPY FOR PRIVACY ACT STATEMENT pgygg ggpy q

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AND ALOUNTS CLAL.S.EDSCHEDU.LE DF EXPEN (See h.RC Appendux 150ffor mstrue.

'*""ou*o*Te**a*er.*wa'*u s.

Com rions for comptering shis[ons)

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-oo sor Remove car PAGE NO, 01V/ OFFICE ID YOUCHER NO.

Name

. DEPART FROM OFFICE O!V.

SU3-UNIT (OATE)

(HOUR)

MM - DD.." " YY 2

70 00 V GILINSKY AM 03 04 80 9: 00U PM OATE NATURE OF EXPENSE AUTHORIZED NUMBER OF AMOUNT CLAIMED MILEAGE OF MILES 19 8 Q

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Rate " "

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~3/4 Depart residence via U.S. government vehicle 9:00 am Arrive Nktional Airport 9:35 am Depart National via EA A-S 10:00 am Arrive New York 11:00 am Depart New York via EA A-S 9:00 pm Arrive National Airport 10:00 pm Depart National via.

U.S. cover==nt vehicle Arrive residence 10:30 pm

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Expenses:

12 00 Taxi - Airport to 6th Avenue- -

Taxi - 6th Avenue to 68th Street 6 00 Taxi - 68th Street to Airport 6 00 1

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5,e Riverse of Payee Copy for Pnvecy Act Statement PAYEE COPY

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