ML19331E291

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Travel Voucher for V Gilinsky on 800622-23
ML19331E291
Person / Time
Issue date: 07/16/1980
From: Gilinsky V
NRC COMMISSION (OCM)
To:
References
NUDOCS 8009090596
Download: ML19331E291 (2)
v • d • e


Text

for Appr) d by the U.S. NUCLEAR REGULATORY COMMISSION {

Comptroner Genw3, u.s.

TR AVEL VOUCHER (Part 1)

~

(Sre ARC Appendix 1501 for instructions for wmpleting tids form)

M*1 2. 1972 (Do.Yot Rrrwon Carbqns)

WM 1.

2. Diviseonf 0ffice 3

' 4. Address Code S. Name af Traveler (Ferst two snessais and last name)

Di Code Voucher No.

' f Amendment (leave blank)

Osome O utf ce a-B.

..A

'*7 0 % 00 j

Vl lGILIUSKY Speciai y

6. e. Madmg Address (P.O. Box, streer or othee)

D. City, State

c. Zip Code OCM, Room 1103, H-Street Washington, D. C.

20555 R

t. Residence of Odifent from item 6
8. Offcal Outy Station (Csty, State)

For Travel a% otner Expensee

  1. "$theads,im Washigston, D. c. *"* W S 80 j '" '" @378 0 NRC TO BE BILLED:
11. Number Page 13. Enter
14. Identification
15. Carrier or
16. Pomts of Travel Covered by
17. Mode and
18. Amount Each Page No.

Appt late TR No., invoice Rental Car TtR or Period of Car Rental Class of Service to be Billed Consecutsvely Type No.,

(Name or (MM 00 YY)

Here etc (see instruc-Initiais) 1 tions)

12. Number item TYPE From To E

y Each lism CODES

...I Consecutively 9

Round C 43514409.L Hertz 6/22/30 6/23/80 S37.12

^"'"

M'""P Trip B=TR oa*

f Way.

C=

>I Rental e

Ca De GEBAT Em other

19. Number of Bemng items if more space is required for Mditional bill 6ng items, use another
20. Total amount Usted on this Page Form NRC64, and complete iterns 1 thru 5, and items 11 tt vu 20.

t ed on y, y f"

21. Authortzation
22. Travelor's Social
23. For Change of Duty Station-Ir6dividuals included in this Claim:

MgNoQQgfg O Employee No. of Children Agee 12 to 20.

24. Read Carefu y (tt voucher inciudes' anrg the '

empioyee and Spouw n

toinwmg;, tnerk the.sporopriate bases %

cd ~

Spouse No. of Children Under 12 Youcher in'lu' ee StEred Cost (Explain in Part 2.)

O Coasaiani'tr'a;.i:E4.,Geowres H(2) t/MD t/DDs-23,cTravei Advance (For Othee or CourRottER Use)

O Abandonmeat at Fa ei.(Earl =awart.2.O.:sc to btoe gt "'*!'a8*8.b*a 'a m s A u n w n s:. A ts 2ns u 4d ';

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O Compar=we Cost Statement >naudados uc2 m.q pittp c-

<^mt.aa,' to ba.mapWms2 c,e cam,x qin!ueng '

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.c O Laave TallenJes ConjunctioniwittbTrtp.(Explala, dig rarf j2.l3G U 7tpBalancejatfamast(outatanding. ti! A L GOG:.m C41d 'OMC[ ?

't,'T'S Local Travaqa Encntme 0,qst BE Gmq W ** d*' "f' . *."f" ?'"* 'f **r'"" b "***"* U'!!^ VN" !2 t

A AdditionalNouchers will~ be Sutiroitted*t261.li.;.,f ujE A p& M UIGq' 20p'M 9;1CU G' "JG 70CGl 2CC*1L*/.. U TJQ R '2 Sn@OL?CQ S

O Refund Due on Un,used gandfor,fjefund Slip (EApAsin hy $ 27 dl

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~r O a*mittance Attachad?t Amt ofKOO' ' " _ ' ' " - MO6;c,~,.

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Examined by:

Aj.J%Date / # WV

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., 'S&edute No. For Othee b. 29, Total Amount Claim 9t' W '

30ATotal Fore *gn CostV W J1NN'et WTraveler (For Ottece

' 27. Actual Time in Travet for(G 28.

m,CgN,TROtLER Uset,. _w to,..$ 52e 50.6.- '-

~ incium.in nern 29 -

of erRou4 va2 to Per D.em Calculation,

or

.-m-

,e v ~ eg o,y, oo,,,e,c.

a, r

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e c,13qlCt9} biCCGGQL.}. 32)Certsfaed Correct Payment or credit has not beeri recevM*4 W ' ' " " "

%aip,,oy

.tions at,02 mLwgu ;unic9tG2 s joj9t:0.; ot bdc'JIR " % 0L m ;;m tuu :e g contF c; 9u any tract.

a.' ci ece casu v7 c [o game.m wep

, qpt,osa n w ech.>= ~ a"me c d.o ;

., J O.3, is saature of Treveier3 r.,w i a ca apenenr# /

,,,, c, u,, m u em < o i ;> t ie = r.

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33. Approved. l ong distance telephone calls are certified as r~aaaary
34. Certfied Correct and Proper for Payment

' 6, U ' r..

T iC a q J:,.i 0; is c OU CXDGUcG7' in the tpterentet the Wten{pOLp6q {L9 %l G/DCU$i' WL T W. "Clw : E WB0282) f u; cant!ou

cas a.; rps ; cut p rm, to u.n tqwprtwisa
C: spa Victor.Gilinsky, Coranissionor 7m/h

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(signature ot Approdng Othciet),**

',. JDete), s /. / ),..

yuthoriied Certstymg Ottocer),,. _.,. e ; ~

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,,,. m(Datep p q,,,,,.

~35. Accounting Clas's fication (For Ot. ice of CONTROUER Use): r use):~

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Detail.p~ f R Class.

omect,-

r m,v; w o m vi e,owecter.

n:-

m.

^<:-

' owecer 3

B Arrtount _

Class Detail B & R Class Amount Class Detall B & R Class Amounf' Class A

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Frruduient Cia.m-Faisification of an item in an expense account works a forfeiture of the claim (28 U.S C. 2514) and mar result m a hne of not more than $10.000 or

l imprisonment for not more than 5 years or both (18 U.S.C. 287; id,1001).

"If tong Distance teiephone calls are included, the approving officer must have been aathorized m writing by the head of the Department or Agency to so certify (31 U S C. 680a).

PAYEE COPY SEE REVERSE OF PAYEE COPY FOR PRIVACY ACT STATEMENT

.THIS;D.O.CUMENT.J.00..NTA. INS 2

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_6509090 gJ p00R.QUAUTY PAGES

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1.k 4

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'r SCHEDULE OF EXPENSES

"' W '"#" N 'his Comptro e Geners U.S.

tnons r completing t rm

- uar 2.1972 AND AMOUNTS CLAIMED i

-Do Not Remove Car ons)

PAGE NO.

D ()FFI VOUCHER NO.

Name DEPART FROM OFFICE UNIT (DATE)

(HOUR)

MM DD YY AM 1

70 00 V. GILINSKY 06 22 80 n

E PM DATE

. NATURE OF EXPENSE AUTHOF<tzEO NUMBER OF AMOUNT CLAIMED s

MILEAGE OF MILES 80 1,

ne,e 6/22 Depart Residence via U.S.

5:00 p.m.

covernment auto Arrive National Airport DeDart National DL-211 Sr55 n_m_

Arrive Atlanta 7:35 '.m.

p Depart Atlanta DL-212 8249 n_m.

Arrive Chattanooga,.Tenn.

9:30 p.m.

Pick up Rental Car 6/23 Tour of Sequoyah Nuclear Facility 6/23 Depart Sequoyah Plant 4:10 p.m.

Arrive Chat &mnnoaa 5:00 n_a_

Turn in rental car (receipt attanh.A)

Depart Chattanooga DL-839 5:40 p.m.

Arrive Aelanta 7.nn n_m_

Depart Atlanta DL-506 8:00 p'.m.

Arriv. umeinnal i n_. n_ n_

,n _ _ _

Arrive Residence via U.S.-

' a ceiver 7ne 'v.h 4 r l.

10;30 p g anciosi pen..,;ca Coww!ac'N e, c. nm r mmoom u;LCyBL

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Grand total (Amt to be Shown en item 29. Part 1)

See Reverse of Payee Copy for Privacy Act Statement PAYEE COPY

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