ML19312D002
| ML19312D002 | |
| Person / Time | |
|---|---|
| Issue date: | 03/26/1979 |
| From: | Gilinsky V NRC COMMISSION (OCM) |
| To: | |
| Shared Package | |
| ML19312C990 | List: |
| References | |
| NUDOCS 8002080350 | |
| Download: ML19312D002 (2) | |
Text
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@M,n ny in, U.C NUCLEAR REGULATORY COMMISSION Compsratier Gastr 3, U s.
TRAVEL VOUCHE R (Part 1)
May 2,1912
(.
.<C Appendo c i301 for instrtsction s for completing sm)
~~ v (Do hot Remove carbons)
S. Name of Traveeer (Fust two ensnais and last name) g@ 4. Address Code t
Code vouch,No.
1.
- 2. Dmenonsortico 3.
Hom* D o'iice s
4
- d**'
tieave tsaam) g *O
~70
&?t 00 M O specw v
l GILIusn a.
B.
b4
- s. o. Ma.ung Address te O. son s,reet or Omeo)
- b. city, state
- c. op Cod.
CCM, Room 1103, H-Street Washington, D. C.
23555 T. Ree dence if bMe~re~nt from item a
- s. Officias Duty sianon (cery, sise)
For Travei e,JDihn Esponsee
$*besda,Md.
Washington, D. Ce "dNM l'"*D N 8b o
NRC TO BE BILLED:
- 11. Number Page 13. Enter
- 14. Identification
- 15. Carrier or to. Poents of Traves Covered by IF. Mode and 18 Amount Eactl Po0e No.
Appropr6 ate TR No., invoice Rental Car Tf R or Per6od of Car Rental Case of Service to be Billed Cone cutsvoly pe Code No.,
Name or (AdM 00 YY) t e oto (see instrue-nsrials)
,./-
1 fions) i A U L8
- 12. Number item TYPE From To r
u y
Each item CODES Consecutively 4 M.',
'#.~
-J-9 taeg6nn6ng A = TR witn "l' Hound
+*. ~ s?
Trip 4'
. l on.TR B=
\\.
Way s
k
' \\
Ce Rental
\\
Car a
De
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GESAT Ea Other
- 19. Numoer of Billing items il more space is required for additional talling iteme, use another
- 20. Total amcunt Lided on thea Page k
Form NHC64, and complete items 1 thru S, and items 11 thru 20.
to be billed on this pace
- 21. A tnorizahort
- 22. Travoier's Social
' 23. For Change of Duty Station-Indwiduals included in this Claim ~
anoa 13'1 M -easi O Empioyee No. of Ch.idr.n Age. i2 io 20.
and Parents
- 24. Reed Carefully (it voucher includes any of the Employee and $pouse following mark the sppropriate bores):
O voucher iaciudee saared Coei (E,aisen in eart 2.>
0 Spau'e No. of Children Under 12 O Coaeviiant Traves : pensee caimed
- 23. T,.ve Advanc. vor 0,t,ce o, CONT,Ottfa U,e)
MM Ouistandmo baiance O Abaadoament of Treves (Enessen sa rare 2.>
8-0M Amouat to be appiied O Com~perosive Coat statement inciudad WM e=>aace ia remaia outstaadina O Leeve Takea ia Contuactioa with Trip (E,,iam in eart 2.>
- 26. Ver Ottsce of CONTAOLLE8 UsE) Eneminer's Deductione Local Trevel Q Additional Vouchers w6ll be Submitted Q Refund Oue on Unused T1chet andf or Refund Silp (Esplein in er. 2)
' Remittance Attached in Amt. of 8 - !
+
g
'"... 'r Q House Hunting
- 'J '
Examined by:
Date
- 27. Actual Tirne 6n Travel for
- 28. Schedule No. Vor Office
- 29. Total Amount Cla6med
- 30. Totat Foro6gn Coets
- 31. Not to Traveler Vor Off>ce Per Dem Calculasson of CONTRotLER Use) included in item 29 of CONTMOLLER Use) s y '.
Days Ouarters
, n.,
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O,
- 22. Corinned Co, rect Paymoni o, c,od,i na. not been,eceived-
.-. t.a ;.u e
'm any tr.e.
. a : x g. m :r g2 g,*
gg y/
~
[
O3 (sianeture of Trevera)
.(oorese a m %
- 33. Approved. Lon0 distance telephone calls are certified se neceanery
- 34. Certified Correct and Proper for Payment
~. pa,.M"
.E. o,y.
m In the laterest of the Oovernment.
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s.
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. ; %ggk[.,,
. - ~ -
(Signature of Approving Official) "
(Dete)
(Authorited Certifying Officer)
(Dete) m&
. 36. Accounting Claestfacetton Vor Ottice of CONTROLLER Use): r Use):
1: g rN j
~ ' ' ' '
W B & R Class l Arnount t
Oass Detail B & R Q ass Amount De nit 8 & R Class Amount Class Detall C8ase e
A B
C D
E F
N I'raudulent Claim-Falsahcanon of an item ln an esponse account works a forfeiture of the cla6m (28 U.S.C. 2314) and may result in a fine of not moru than 510,000 or
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t
, Imprisonment for not more than S years or both (18 U.S.C. 28t; id.1001).
5"..
4 oi u.s".E.Datance telephone calls are included the approving officar must have been authorited in writing by the head of the Department or Agenc "If L se0.).
m seg savEnsa or ravse Cory FOR rasvaCY ACT STATEMENT
' ORIGINATING OFFICE COPY c., d & O 8 0 w
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.~.,.m-eenc erorm as A (5 tal e
f 2."NEl.
HE*') (PART 2)
(See N,,,RCAppemilx 1,,3,:1 for,insame.
^
re m Aoorown my1no SCHEDUI.E OF EXPENSES s
,,, f,,,,,,,,,,3, f,,,
cemieiromer c,eaer:s. u.s. '
AND AMOUNTS Cl. AIMED
-oo Not a,more carbons /
- * * ^ " "
A WC E N 3.
DIV/ OFFICE 10 VOUCHER NO.
Name DEPAR T P'aOM Opfrict - 4 Olv.
SutbuNIT (DATE!
(HOU R)
"g
'70 00 V. GILIllSKY 3
25 79 '
rm KJpM -
CATJ NATURE OP EXPEN$E AUTHORIZED NUMBER OF AMOUNT CLAIMED MILE. sG E OF Mit.ES e.
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nate e
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Travel scheduled from Washington, D. C.
N to Morfolk, Vircri n 4 m arid r M urn sran f< *M i-cancelled.
Unused airline ticket is
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2 returned her_ewi3h.
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v ORIGINATING OFFICE,m"OPY5,a i
asa sienne se payee copy for p,wacy Act statyment s...x :
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