ML19312C994

Travel Voucher for V Gilinsky on 791022-23

ML19312C994
Person / Time
Issue date:	10/30/1979
From:	Gilinsky V NRC COMMISSION (OCM)
To:
Shared Package
ML19312C990	List: ML19312C989 ML19312C991 ML19312C992 ML19312C993 ML19312C994 ML19312C995 ML19312C996 ML19312C997 ML19312C998 ML19312C999 ML19312D000 ML19312D001 ML19312D002 ML19312D003 ML19312D004 ML19312D005
References
NUDOCS 8002080327
Download: ML19312C994 (2)

Text

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U.S. NUCLEAR REGULATORY COMMISSION l

Comperceier o.aerei, u.s.

A TRAVEL VOUCHER (Part 1)

M*f 2.1972 (See MEC AppendirJ'501 for. instructions f>r mmpleting this form) p a 3 **T } O G5 $.,tJ (Do.Yot Remo.w Carbons)

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s. Oivts on# Oftece 3.

4. Address Code S. Name of Traveler (First two messais and test name) ~

Code Voucher No.

. g Q**Q g.C' ** N.cJ.

n

___t (leave blank) 6 ri,en e C Office a.

g, O wJ O "in N*t on aspecw VllGILIUSKY

.. o. samn Addrew (r.o. am. 4, root u omos)

b. Cay. Siate

c. zip Code d

OCM, Roosa 1103, H Street Washington, D.C.

20555 W#

' F, Residence if Oittwent from item 6

8. Official Outy Station (Cary, State)

For Traves and other Expensee

'wM. 3 ' p l 10. To:-(MM 00 W) -

9. From (MM 00 W) hCary, }tesda, MD Unshington, D.C.

In/w /70 rate)

In /n /sou et NRC TO BE BILLEO:

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.18. Numoer Page 13. Enter

14. Identification

15. Carrier or

16. Pomts of Travel Covered by

17. Mode and

18. Amount Each Page No.

Appr 6 ate TR No.. Invo6ce Rental Car TIR or Period of Car Rental Casa of Serv 6ce to be Billed - ?

Consecuteveer Type No..

(Name or (MM 00 YY)

,.4 1., f x.y. l 3

Here etc (see instruc.

Initiets) 1

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12. Numoer item TYPE From To Ud 9r Each item CODES Consecutively s y Las c;g.

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Bacinn6ng A = TR i

with "I' Round

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Trip t

B = TR One Way C=

Rental Car O=

GEBAT Em Other 19, Number of BiHmg items if more space is required for additional bilhng items, use another

20. Total amount usted on this Page L

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

to be bdled on F

this pace

21. Authorizabon

22. Traveler's Social

23. For Change of Outy Station ~1ndividuals included in this Caim:

No.

Security No.

O.Y S**;b i 133-26-8067..

' 24. Road Carefully-(tf voucher includse any of the- -

O Employee No. ct ChHdren Agm 12 to 20.

and Parents Q Employee and Somse

. fo!!owong; neern 1990 appropriate besee}&

Spouse No. of Children Under 12 Vouchee locludes Shared Cost (Espieln in Part 2.)

O Coasuitant TraverEspensee Ctaimes 3 z e. : yeu.2n.Travei Advanc. ifor oft,ce of CoNrnottEn use)

O ^=? d Travoi.(E=atis.a f.ad 2%, <,-. s to bio #f*FMMS;us u.:ia.n uat an: La qi._ *.%ca-O Comp-see Cat simen=U,acaud=d =.r : uq my u-na^"!"a2 ta?Ra'$.m::s Cm. cup ps gemhz? y r,"*W t ma' nswi'

' O to ve Takeat Coaiuactica. wiia Trip. (E=a' a.'rr eart,2,)s, 0. 8*'*aca 'a r***ia au'*taadias" > i s.

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, Q House Hunting

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t 2(. Actual Time.6nt Travel fo%

2SCsmodule No.rtfor OttwG

29. Total ArnountiClaimed uJ 30.J Total Foreig!t. Costs he ?g310 Net se Traveler (For Office -

JI CONTactLEft use)oe..'00rJ-Per Diem Calculation of CONTAottER lise).

aua u.sw. Item.e.;-.xt jncluded in 29 s

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34. Certified Correct and Proper for Payment

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33. Approved.' ton 0 distance telephone calle are certlfted as nomssary

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(Signature'of Approving Otticiel) **'[ '*' L','

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Fraudulent Oa.m-Falserication of an item in an expense account works a forfeiture of the cf aim (28 U.S C. 2514) and may result in a ime of not more than $10,000 or P* Imprisonment for not more than S years or both (18 U.S.C. 287; id.1001).

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"**lf '.*s".E0 stance telephone calls are included, the approving officer must have been authorized in writmg by the head of the Department or Agency to ao certify (3t u esoc.

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' PAYEE COPY

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- [.i sEs nEvensE ce parte Cory ron ontvscr Act STATEMENT

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SCHEDULE OF EXPENSES tions for compierins :is form

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AND AMOUNTS CLAIMED

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Man. im PAGE N3.

06V/CfFICE 10 VOUCHER NO.

Name

DEPART PROM OFFICE DIV.

Sus-UNIT (DATE)

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- NATURE OF EXPENSE AUTHORIZED NUMEsER OF AMOUNT CLAIMEQ e; d

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