ML19312C995
| ML19312C995 | |
| Person / Time | |
|---|---|
| Issue date: | 10/19/1979 |
| From: | Gilinsky V NRC COMMISSION (OCM) |
| To: | |
| Shared Package | |
| ML19312C990 | List: |
| References | |
| NUDOCS 8002080331 | |
| Download: ML19312C995 (2) | |
Text
!
....,.~~.-~~sJ w.~-w..~~.,~~-.-:
+..w.,n.,.
k,.
E
- i t.
i
'/~..
l I
NRC64 (%76) por,. App,oved by'. %
-4.
,2 TRAVEL VOUCHER (Part 1)*,
s g
U.S. NUCLEAR REGULATORY COM' MISS40P&
- ia s
the Comen uer cenwa u.S.
,e o
- 2 W2
,RC Apprndis 1501 for instructions for completing
, >r.a)
- r. r..,e~
(lh.Yot Remomr Carbons)
- T - %, 0 V & @ 4 4 3
Q 1.
,12. DeviseontOffice 1
~ ~'U 4. Addres4 M S. Name of Traveier thrst two enetrata and dass name)
Code vouchw No.
t E i
\\
- w,,Q7 Wg Amendment -
(leave blae)
&e' De.. O0" ice g
3 g,
Q t n.t m s
4q. O Cs.,n sun OS-c" ~
I k TTr:cvv
'r u
Ma...no Adoree. (r.o. son, street c, Ott,cef
- b. C.ty. S'me
- c. 9 Gooo 4@,
_ ML Rgort 1103. H Street N3shinnton e D.C.
20555 F. fLs.oenr.e of Ostforent froen item 6
- 8. Officia' Outy Station (C,ty, State)
For Travel and Other Espanses (Csty. Statep.
- 9. From (MM DO YY) en n o m # i"+8 U
'Octhesda. MD V$shinton. _ DeC, l 10. To:
(MM 00 YY)-
N" sM innrno
~'#
NRC TO BE BILI.ED:
. W%.
+
it. Number Page 13. Enter 14.Ident:0 cation
- 15. Carrier or
- 16. Points of Traves Covered by
- 17. Mode and
- 15. Amount 7 - -
- Each bGe No.
Approcriate TR No.. Invoice Rental Car TlR or Pened of Car Rental Class of Service to be Bailed 6 M Consecutsvoly Type Code No.,
(Name or (MM OD YY)
$. 4-k 3..
Here etc (see ustruc~
hiatuals)
.; 2 1
teons)
T f3 W
t
- 12. Number item TYPE Each item CODES From To
'*'*IJ.
/
,P 4
Consecutively
- ' **M Bn=ao
^=Ta C 72360726 4 HERTZ 10/17/79 LO/19/79
$32i:S0 Wi with "1 Roun't i @m w Trip
,fc.5. %
)
BmTR
.: M*
One W.?
Way
't% 9 M.
Rental Car c.G-?.' N De
- :J
- GE8AT
.1 L Em Other 1 A Numtner of Bilung items it more space 6s required for additional billing items, use another
- 20. Total amount Lasted on this Page L
Form NRC6a, and complete items 1 thru S, and 6tems 11 thru 20.
to be billed on 7
this pace
- 21. Authorization
'2. Trave 6er's Soc 6al
- 23. For Change of Duty Station-InJividuais included in this Claim:
No.
Security No.
1 M.M*u oA7 O Employee No. of Children Ages 12 to 20.
~
2s. Reed Carefutty (it voucher include any of the Ionawing, marnt the approproate bonee):
O Employee and Spouse O vrucher includes shared Casi tera'a'a 'a e= 21 OSe
- * "r'a * "
O Coasuitsai Travei E peasas C =med 25 *'*e' ^ '*aca ('a' o"'c co*'ao"ea u'e>
Abandonment of Travel (Expla.n in Part 2.)
Outstanding balance 8 MEM O Comparative Casi Statsmaat inciud d
^**ua' b* *pa'ied
'M O Leave Taxea ia Coniuaci+oa wita Tr's ters'a'a 'a Part 2 >
8 *"c' 'e* *'a 'u'ad' a'
' ' ' " ^
- O 5.acai Trev.,
2s. (For Ott,ce er CONrHottER use) Eivnener oeductions Q Additional Vouctiers will be Submitted
- *E T
S Refund Due on Unused Tictist and/or Refund Slip (Esplain in Pt. 2) 777 y
' g gg 7_
g-g O Remittance Attached in Amt. of 5 l
3, y7 Q House Hunting
= = A. fM[- -
Examined by:
Ato '
,27. Actual Time in Traves for 2lL Smedule No. (For Ottice
- 29. Total Amount Claimed
- 30. Totas Foreign Costs
- 31. Not to Trave 4r TI orl/fice l
F Per Diem Calculation of CONTROttER Use) inciudad in item 29 of CONTROLLER Use) ;..p" k.
Days Quarters espo en 31 rg.M,.w.A a
ne 9
- 32. CertiTied Correct Payment or credit has not been received' f WQ.gus b(
g,. gegeg e any free.
~
teens of G2 a day) w>M tM&.m @'S
~"L 3
1 (signature of Traveler)
-(OnteY *.n T W I
- 31. Aporoved. Lon0 d6etance too.g., calls are certified as nara-y
- 34. Certified Correct and Proper for Payment
/ + hm a.S.
in the interont of the Govertirnent.,
,, fQ ' V*
gl
. ;.c M h 4
5 YG.
k,kh l
(Signeture of Approving Ottirial) "
(Date)
(Authorized Certifying Ottocer)
' T.e > (Dew) y:fqQ
- 35. Accounting Cassification (For Office of CONTROLLER Use): r use):
.& Qv
- i -
e Oblact Object Object Omi,e Detalt 8 & R Caen Amount case Detail 9 & R Oase Amount C ass Detalt B & R Class Amount (pdI<:
'Q A
B C
M Ifl N
Q8Il
". h.'.'.
D E
F
.Nb
- Fraudulent Claim-Falsarication of an 6 tem to an empense account works a forfeiture of the ctasm (28 U.S C. 2514) and may result in a fine of not enore than $10.000 or !
i impneonmect for not mcre than 5 years or both (18 U S.C. 287; id.1001). - -
- '~
"It cong Destance te4ephone calls are included, the coroving off;cer must have been authorized in writing by the head of the Department or Agency to so certify C)
(31 LASwC, esco).
., s ee <
-y.Q l '.E
- D GRh C OPY.;; % $
SEE MEMERsE OF PAYEE COPY FOR PMIVACY ACT STATEMENT 1-
- T m-
~-
- * ~ ~ ' ' ~ ' - - - ' ~ ' ' ~ ' ' ~ ~ ~ ~ ~ ~ " *
~~~~~~*i~~'
-. ;V8.t.VOUCHt7 (PARf 2)
..-~~.S
.. N.a.c.Fa.em 64.A tus t
. zf '.(,. '
4" ## # d "#'"#*
- I """"'",
-- J
' SCHEDULE OF EXPENSES A
. a ey ine
.ca.ou a ceneau, u.s.
rions for comp!< ting thisfons) ann
{- [.
~.
"*1****
AND AMOUNTS CLAlMED
. -Do Not R1more Car CAGE NO.
OtV/ OFFICE 10 VOUCHde NO.'
Nam.
{P,
,,M
( OUR) g OtV.
SUS-UNif
[
i MM OD i. 7,YY
.d AM
_2
~70 00 V GILINSi2.
10 17 79
$$jd,2.,
DATE NATURE OF EXPENSE AU THO RIZ E J NUMRER OF AMOUNT CLAIMED. 's.'i~.* 1 MILEAGE OF Met.t.S f.
e
.su',.-
~. "* * %.c %w!,.
..m P*.
1979 i
Rate 4
in /17 Depart resad o ce via U.S.
- N$$ #1$
.I enunc ma e vehicia
' W 10 nei w -* M 4
p N N' M
Arrive National Airport
'. M"
- N non.nvr m einnni vin Tu-tas A ra n
- n. n de9 4T-
'M5 Arrive St.. Louis for connection *
~
~~~
u nmer ce_ vni,i vin nn 411 7 ens nn
'-a Ariive Kansas City.for connection 7:55 ixa e
c'W vn m ve... rfev v4. T w t71 orin nm Arrive Phoenix.n<t 9:37 pm nf ot..a,,n.
von c.1 r e,-
m'"..s
~
%i..,o A mes.A,1 e A e t i n h e / e n n n o n. e ; n e.
10/10 nar,ivnoA vnnr51 cJe
~,
i %
~
Depart Phoenix via AA-112 9:15 am Arcivo h119. Ai vn net-6??7 ~,
Depart airport,vih U.S.
~nv en-wn P veh i e 1 m Arrive residence
-t..,..
Actual Expenses Claimed:.
~
(n ot to n,rened AA6 nor dnv1 Ilotel - 10/17 - $44.57#80'.50 46 00 in/1s -
Meals - 10/18 -
6.25
'46 00-
'r:
. '.'+ l L9
- q-NH f.C's. :
'R.
~ "
'.[,
' l.1',h, f[.sk'[ ISd s
v
- O+-
.. =,
.4,.
.s s
.,s, g,
(.g m.-
i.....-3.,.
.I
- ,2ilg
- 4. @%
. ~
..:.=--..-.-
,:~
/R f
c
- D 4. 3. ; - d e
-p :.f j,. Q'fG
(
~
~
~
w pp 7
- 3, M.
.. w
- p,. g
, *l? [-f F, g
3
."('.1). '. '
g
.. e.~.?a &,n e.
.- 1 g;.f%.- M. 5,3 0 *)f,.B y i
y..
...L ) ~
o L,
.,. 9 : 1 ;,
P. 3 3
.w...
j(~.". [. -
..yw-66 d.- [. d * ' '* '. ' l y
- 5.
5
- p, f(
^
.t
- e. *..; e
. ;,.p...-
. o-e +..u -. :
...a,:. c s
' f.\\ '.., l '. ;g
+
)y g'd, ~h wp,...; c ;'>,c;',.
' u
." '*; W.
^.~...:
J t
s.
s.-,
.y/...ar.orand totas (Amt. to me shown in stem 29.- Part 1) pe.g,.. _ $,..
' ' * ^ -.
_ ~......
..,e.4
. a w' 2,'s,,.Q ~,;m.i;, y@ C.
..,K..
3 _.
~ ;*
p
=
n n, p.9
- see steverse of Payee Copy for Privacy Act statementy;r,g,.'y G.?NJa,*J'J <9. g, y, rg f, m ;Q,,,
..r."_...- f f'l,T1 M,., a CA.;.:
C g ',,. ;4 i
u ;;. _~.ff 1. y-Y. '3,, '3. ;&. %.e.,f 1.fM.- - -- y - -. a.w a
.a.,
~
w'nj q._, ; lf.g,
5,
~ !* ' * ' 4 *g*." W Top);
M
,y
, _, _ S :..
- .4 f
,y
- yg ---
.t ~.
m m
'D -
,,