**TQSA**DAILY ITEMIZATION OF EXPENSES CLAIMEDLODGING: Receipts are required
LOCATIONDAILY COST**TQSA**DEPN

MEAL/LAUNDRY: Receipts are required for Laundry & Dry Cleans Yen Rate Use Military Banking Rate at:
Date

Yen Rate

Lodging
Yen
DollarYen

Breakfast
DollarLunch
Yen

Dinner
DollarYen

DollarPERIOD
FROM:
TO:
FROM:
TO:
http://www.usfj.mil/
Landry & Dry Cleaning
Yen
Dollar

¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1¥1¥1¥1¥1TOTAL AMOUNT OF MEAL/LAUNDRY CLAIM
TOTAL AMOUNT OF LODGING CLAIM
GRAND TOTALTQSA claim for1st 30 days _____________
2nd 30 days _____________
3rd 30 days _____________
AF Form 3125v1.2 Mar 83 (OVERPRINT AS MODIFIED)

Daily Total

Lodging Total

$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

$0.00

I CERTIFY THE ABOVE INFORMATION IS TRUE AND CORRECT. THIS INFORMATION IS SUBJECT TO AFOSI REVIEW.
FALSIFICATION MAY LEAD TO DISCIPLINARY ACTION, UP TO AND INCLUDING REMOVAL.

_______________________________________
SIGNATURE_____________DATE
GENERAL PURPOSE

**TQSA**DAILY ITEMIZATION OF EXPENSES CLAIMEDLODGING: Receipts are required
LOCATIONDAILY COST**TQSA**DEPN

MEAL/LAUNDRY: Receipts are required for Laundry & Dry Cleans Yen Rate Use Military Banking Rate at:Date

12/10/2019
12/11/2019
12/12/2019
12/13/2019
12/14/2019
12/15/2019
12/16/2019
12/17/2019
12/18/2019
12/19/2019
12/20/2019
12/21/2019
12/22/2019
12/23/2019
12/24/2019
12/25/2019
12/26/2019
12/27/2019
12/28/2019
12/29/2019

Yen Rate
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1

Lodging
Yen
Dollar
$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00

Yen

Breakfast
Dollar
$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00Lunch
Yen

Dinner
Dollar$30.00$30.00$30.00$30.00$30.00$30.00$30.00$30.00$30.00$30.00$30.00$30.00$30.00$30.00$30.00$30.00$30.00$30.00$30.00$30.00Yen

Dollar$40.00$40.00$40.00$40.00$40.00$40.00$40.00$40.00$40.00$40.00$40.00$40.00$40.00$40.00$40.00$40.00$40.00$40.00$40.00$40.00PERIOD
FROM:
TO:
FROM:
TO:
http://www.usfj.mil/
Landry & Dry Cleaning
Yen
DollarTOTAL AMOUNT OF MEAL/LAUNDRY CLAIM
TOTAL AMOUNT OF LODGING CLAIM
GRAND TOTALTQSA claim for1st 30 days _____________
2nd 30 days _____________
3rd 30 days _____________
AF Form 3125v1.2 Mar 83 (OVERPRINT AS MODIFIED)

Daily Total

Lodging Total$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$1,800.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$2,260.00$4,060.00

I CERTIFY THE ABOVE INFORMATION IS TRUE AND CORRECT. THIS INFORMATION IS SUBJECT TO AFOSI REVIEW.
FALSIFICATION MAY LEAD TO DISCIPLINARY ACTION, UP TO AND INCLUDING REMOVAL.

_______________________________________
SIGNATURE_____________DATEGENERAL PURPOSE

Effective 06-14-17
RECEIPTS REQUIREMENTS
Receipts are not required for any single meal, per person that does not exceed those meal rates.
MEAL RATES:ADULT CHILD (Age 11 and below)**
BREAKFAST: $10.00 $5.00
LUNCH:$15.00 $10.00
DINNER:$20.00 $10.00
Only actual subsistence expenses incurred, which are reasonable in amount and incident to the occupancy of temporary quarters shall bereimbursed. Estimates and/or flat rates are not authorized. Receipts must be submitted with the dialy expenses claim sheet in order torecieve reimbursement for lodging and laundry. Employees are highly encouraged to maintain documentation and/or receipts for all meals, as
the 18th Force Support Squadron, Civilian Personnel Section reserves the right to request documentation for any single meal purchase thatexceeds the above "Meal Rates."** Adult Meal Rates apply to children whose ages are 12 and older.
I understand that I will claim actual expenses, and receipts are required for meals, per person, that exceed the meal rates shown above. I
further understand that receipts are required for lodging and laundry.

Date: _____________________

Signature: _________________________________________

OFF-BASE TEMPORARY QUARTERS REFERENCE
HOTEL

PHONE NO.

PRICE PER NIGHT

PET ALLOWED

Hamagawa Lodge

936-7139¥11,000 ~Yes

Crown Hotel

933-2551¥8,000 ~No

Eagle Apartment

936-3651¥10,000 ~Yes

Hotel New Century

933-5599¥9,500 ~No

Hotel Grand Mer.

931-1500¥9,500 ~No

**TQSA**DAILY ITEMIZATION OF EXPENSES CLAIMEDLODGING: Receipts are required
LOCATIONDAILY COST**TQSA**

DEPN

MEAL/LAUNDRY: Receipts are required for Laundry & Dry Cleans Yen Rate Use Military Banking Rate at:Date

12/17/2019
12/18/2019
12/19/2019
12/20/2019
12/21/2019
12/22/2019
12/23/2019
12/24/2019
12/25/2019
12/26/2019
12/27/2019
12/28/2019
12/29/2019
12/30/2019
12/31/2019
1/1/2020
1/2/2020
1/3/2020
1/4/2020
1/5/2020
1/6/2020
1/7/2020
1/8/2020
1/9/2020
1/10/2020
1/11/2020
1/12/2020
1/13/2020
1/14/2020
1/15/2020

Yen Rate
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1

Lodging
Yen
Dollar
$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$226.00$226.00$226.00$226.00$226.00$226.00$226.00$226.00$226.00$226.00$226.00

Yen

Breakfast
Dollar
$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$20.00$40.00$40.00$40.00$40.00$40.00$40.00$40.00$40.00$40.00$40.00$40.00TQSA claim for1st 30 days _____________
2nd 30 days _____________
3rd 30 days _____________
AF Form 3125v1.2 Mar 83 (OVERPRINT AS MODIFIED)

Lunch

Dinner
DollarYen
Dollar$30.00$40.00$30.00$40.00$30.00$40.00$30.00$40.00$30.00$40.00$30.00$40.00$30.00$40.00$30.00$40.00$30.00$40.00$30.00$40.00$30.00$40.00$30.00$40.00$30.00$40.00$30.00$40.00$30.00$40.00$30.00$40.00$30.00$40.00$30.00$40.00$30.00$40.00$60.00$80.00$60.00$80.00$60.00$80.00$60.00$80.00$60.00$80.00$60.00$80.00$60.00$80.00$60.00$80.00$60.00$80.00$60.00$80.00$60.00$80.00TOTAL AMOUNT OF MEAL/LAUNDRY CLAIM
TOTAL AMOUNT OF LODGING CLAIM
GRAND TOTALYenPERIOD
FROM:
TO:
FROM:
TO:
http://www.usfj.mil/
Landry & Dry Cleaning
Yen
DollarDaily Total

Lodging Total$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$90.00$180.00$180.00$180.00$180.00$180.00$180.00$180.00$180.00$180.00$180.00$180.00$3,690.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$113.00$226.00$226.00$226.00$226.00$226.00$226.00$226.00$226.00$226.00$226.00$226.00$4,633.00$8,323.00

I CERTIFY THE ABOVE INFORMATION IS TRUE AND CORRECT. THIS INFORMATION IS SUBJECT TO AFOSI REVIEW.
FALSIFICATION MAY LEAD TO DISCIPLINARY ACTION, UP TO AND INCLUDING REMOVAL.

_______________________________________
SIGNATURE_____________DATE
GENERAL PURPOSE

Effective 06-14-17
RECEIPTS REQUIREMENTS
Receipts are not required for any single meal, per person that does not exceed those meal rates.
MEAL RATES:ADULT CHILD (Age 11 and below)**
BREAKFAST: $10.00 $5.00
LUNCH:$15.00 $10.00
DINNER:$20.00 $10.00
Only actual subsistence expenses incurred, which are reasonable in amount and incident to the occupancy of temporary quarters shall bereimbursed. Estimates and/or flat rates are not authorized. Receipts must be submitted with the dialy expenses claim sheet in order torecieve reimbursement for lodging and laundry. Employees are highly encouraged to maintain documentation and/or receipts for all meals, as
the 18th Force Support Squadron, Civilian Personnel Section reserves the right to request documentation for any single meal purchase thatexceeds the above "Meal Rates."** Adult Meal Rates apply to children whose ages are 12 and older.
I understand that I will claim actual expenses, and receipts are required for meals, per person, that exceed the meal rates shown above. I
further understand that receipts are required for lodging and laundry.

Date: _____________________

Signature: _________________________________________

OFF-BASE TEMPORARY QUARTERS REFERENCE
HOTEL

PHONE NO.

PRICE PER NIGHT

PET ALLOWED

Hamagawa Lodge

936-7139¥11,000 ~Yes

Crown Hotel

933-2551¥8,000 ~No

Eagle Apartment

936-3651¥10,000 ~Yes

Hotel New Century

933-5599¥9,500 ~No

Hotel Grand Mer.

931-1500¥9,500 ~No

**TQSA**DAILY ITEMIZATION OF EXPENSES CLAIMEDLODGING: Receipts are required
LOCATIONDAILY COST**TQSA**DEPN

MEAL/LAUNDRY: Receipts are required for Laundry & Dry Cleans Yen Rate Use Military Banking Rate at:
Date

1/14/2020
1/15/2020
1/16/2020
1/17/2020
1/18/2020

Yen Rate
¥107
¥107
¥107
¥107
¥107
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1
¥1Lodging
Yen
Dollar¥20,484¥20,484¥20,484¥20,484¥20,484

Breakfast
Yen
Dollar¥766¥1,032
¥410

Lunch
Yen

DollarDinnerYen
Dollar¥5,643¥11,510

PERIOD
FROM:
TO:
FROM:
TO:
http://www.usfj.mil/
Landry & Dry Cleaning
Yen
Dollar

¥1,040.00$143.75$143.75

TOTAL AMOUNT OF MEAL/LAUNDRY CLAIM
TOTAL AMOUNT OF LODGING CLAIM
GRAND TOTALTQSA claim for1st 30 days _____________
2nd 30 days _____________
3rd 30 days _____________
AF Form 3125v1.2 Mar 83 (OVERPRINT AS MODIFIED)

Daily Total

Lodging Total$59.90$117.21$13.55$143.75$143.75
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$478.16$191.44$191.44$191.44$191.44$191.44
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$957.20$1,435.36

I CERTIFY THE ABOVE INFORMATION IS TRUE AND CORRECT. THIS INFORMATION IS SUBJECT TO AFOSI REVIEW.
FALSIFICATION MAY LEAD TO DISCIPLINARY ACTION, UP TO AND INCLUDING REMOVAL.

_______________________________________
SIGNATURE_____________DATE
GENERAL PURPOSE

Effective 06-14-17
RECEIPTS REQUIREMENTS
Receipts are not required for any single meal, per person that does not exceed those meal rates.
MEAL RATES:ADULT CHILD (Age 11 and below)**BREAKFAST: $10.00 $5.00
LUNCH:$15.00 $10.00
DINNER:$20.00 $10.00
Only actual subsistence expenses incurred, which are reasonable in amount and incident to the occupancy of temporary quarters shall bereimbursed. Estimates and/or flat rates are not authorized. Receipts must be submitted with the dialy expenses claim sheet in order torecieve reimbursement for lodging and laundry. Employees are highly encouraged to maintain documentation and/or receipts for all meals, as
the 18th Force Support Squadron, Civilian Personnel Section reserves the right to request documentation for any single meal purchase thatexceeds the above "Meal Rates."** Adult Meal Rates apply to children whose ages are 12 and older.
I understand that I will claim actual expenses, and receipts are required for meals, per person, that exceed the meal rates shown above. I
further understand that receipts are required for lodging and laundry.

Date: _____________________

Signature: _________________________________________

OFF-BASE TEMPORARY QUARTERS REFERENCE
HOTEL

PHONE NO.

PRICE PER NIGHT

PET ALLOWED

Hamagawa Lodge

936-7139¥11,000 ~Yes

Crown Hotel

933-2551¥8,000 ~No

Eagle Apartment

936-3651¥10,000 ~Yes

Hotel New Century

933-5599¥9,500 ~No

Hotel Grand Mer.

931-1500¥9,500 ~No