.Standal'd Form No. 10i2a-Revfsed :Jrou .. .A.l!'l'ROVEI) BY 

CO:r.t:PTROLLEB GENERAL. U.S. J'ul;v 19, 11!37 (Amended ~ug. 27, 11141) 

Genotal :Regulations No. 88 

A REF ID:A59507 A 

VOt!llER FOR PER DIEM AND/OR REIMBURSEN!RT 

OF EXPENSES INCIDENT TO OFFICIAL TRAVEL 

D. 0. Vou. No.-------------------

Bureau No. ------------------------- (Stalement of auount must he completely filled in by payee prior to signature, and there muat not be any erasure or alteration unless initialed or signed by him) 

General Accounting Oflice 

PREAUDIT 

Certl1led for payment in tho 

sum of S------------------------ Oo111naOLLEB GENERAL or !rHE UNI:rED ST~TES 

u. s. ---------------------------------------------------------------------- PAID BY 

(Department, bureau, or esta!J!Jshmcnt) 

~ 

THE UNITED STATES, Dr., Tdfil'lta•_ia ... b1 .... D-

(PBY11") 

-------~--l!.wlnuJ4_.Ar~--YU&tDSa.----- cAddress> 

Official Headquarters ----------------------------------------------------

B;v ---------------------------·- Dornicile -------------------------- Residence ---------------------------- (For use of Postnl Service only) (For use of P..,.lns Office) 

.AMOUNT 

FOR PER DIEM in lieu of subsistence, mileage for privately owned motor vehicle, and/or REIMBURSEMENT DOLUBll CBt."'?B 

of 1.1vel and other expenses paid by me in the discharge of official duty fro4-..&wauat-----------------------• 19..\s, 

to~ ____ 8'.R1r_. ______ , 19'5_, as per itemized statement within, under authority Noo.de•de.ted--Sl--~-----• 

1~.S_, copy of which is attached,* or has been previ~usly furpished with voucher No. -----------• paid ---------------------• . 19 ______ , by ----------------------------------------=----------------- _ - - $ ------------ ------- 'N amq of slisbursing officer) - (Payee will NOT uae this •pace) 

Difierences_ _______________________________ ------------ -------- - --------------------------------------------- ------------ ------- ----------------------------------------- ------------ -------- Account verified correct for _________ $ ------------ ------

11Hc1&·~-t1 ... (Signature or initials) _____________ _,_ _____ ~------------------

A!PJIOPRIA.'l'I()N, LIMITJ.'rION OBPBOJ'EC'l'BnDIOL 

MEMORANDUM 

.ACCOUNTING OLASSIFIO.A.TION (For completion b;v administrative ollice) 

LncrU.'llON 01.l. l'Rolli:C'I? 

A.Pl'RoPBU.'rION Trrr.E 

.llmol!llll.'llON 

.A.:U:OVN'l! 

----------------------------~----------- ---------------------------------------- $ _________________________ $--------------------------

------------------------------------------- ------------------------------------------------------------ ----------------------------- --------------------------- Cosr Acco= Onn:cr OF E:um."Dirtm:1: 

ENCUXllJU.NCB 1-------,,.--------1-------....-------

LIQUIDJ.'tED Symbol Amount Symbol A.mount 

----------------------------------------- $------------------ ----------------- ------------------- $ ______________________ ------------------S---------------

----------------------------------------- ----------------------- ---------------- ------------------- ---------------------- .. ---------------- ----·------- ---------------------------------------- ----------------------- --------------------------------- __________________ _,__ -------------------- -------------

{

on Treasurer of the United States 

Paid by {Check No. --------------• dated -------------------------• 19~~~;· for $___________ in favor of payee named above. 

Cash,$---------• on------------------• 19______ OR01fil!!AL · -------------------------· - .,. .. • (Signature of payee) 

'"If there WBB no prior authority stato circumstances which rendered securing prior authority impracticable. 

@'pp roved for release by NSA on 06-06-2013 pursuant to E .0. 1352a 
REF ID:A59507 

ITEMIZED SCHEDULE OF fl'RA VEL AND OTHER EXPENSES 

1. Date and Jiour of departure from offi.ciel headquarters -----------------..:.----------------------- ----------- 2. Give duty status on first day of voucher period: (Date) (Hour) 

*Arrived at_-=--------------------------------------- on --------------------------------------' 19 ______ , 

for tempOre.ry duty for approximate period ------------------------------------------------------------------------- Approximate date of return to official headquarters·------------------------------------------, 19 __ _ 

3. fState authorized per diem in lieu of subsistence,$-----------------

4;.~ tState-authorized allowance for actual subsistence expenses: Not to e."Cceed $------------------per day. 

s: Where for traveler's personal convenience or through the taking of leave there is interruption of travel, deviation 

from the direct route, or where traveler delays at a place otlier than post of duty, a statement showing the facts 

should appear on the voucher. 

•xr authorit;v provides for travel to more tha.n Olle 1>0lnt, time of arrival and departure from each should be stated In tbe bod:v ofthe BOCODDt in cbronologlcal. order, tlf more tbau: OJle rato of allowance Js authorized, full statoment of applleatloii of each rate must be given fn BOme convenleilt place on thla voucher. 

.AMOUNT NOTATIONS D.4f,5 Olli.R.AOTER OF EXPENDITURE 

('l'o be Itemized b;r the dB;r and tun:v aplamed) 

SUB· 1----;----1----- 19 _____ _ VOU. 

ti.ft London b7 ab at l~o. Y1a ATC pl&sl9 

J.'nived J.aOuu41a fteld• •ev York• at; Oll&O 

Lett Bev Yark Y1& PeDUJ'l't'An1& BR at 0405 

.ln.1Te4 Vaah1Dgt011 at 0840 

NO.•• S1lBSISUNO:ll Omn. 

9/1°" Reported te cluti" &'t 0900 

t..a"t :ta14 ~ 41• to 1Do1'1de )1 Jul.7 1 5 

Ol1 Touch-.. •o. 6201!. Accounts ot a. B. GA!fft'• 

Jla..Sor. '.J>. (211-2&,) • Aa'ted 8 Avgut 1911-5. 

attached hueto. 

re 41• 1a 11n. ot auba1atence1 Prca 

0001 h0\1118 OD 1 .&upa\ 19'5 ~ 08'0 hOlll'9 

14 Septmabel' 19'5. total or "i 4a7a • t1.oo 

c .,11.50 

:t buebJ' certtr.r tb&~ d•1ng tU peia1od I 

COY8l'ed bJ" this 'YOU.Ob.al' 1 I d14 not OCCUJ>J' 

Government 4uutua except cm the toll~ it• 1 

27_.lupat to aa4 1aolu1ng '°.I.up.at "' ld.ght >. 

• ~•ber (1 Jd.gb.t)# and tram 6 Septeab•r t d 

1no1ll41Jt8 12 Beptembei- (5 ntpta) • total ~ 1 

mpt1. * 

Total. per 41.• rw \.\I d&Jf •• I'll 50 X..•• 10 GOYt. b11ie£a 0 t'-.OO ·- 00 

~U1 tare 'fr• ~ P1eld. 

to PemutJ'lftll1& atat1au 

Jt&:tl.J'oad f'&N baa Xev l'ork 01t:r 

to Vaah11Jgtcm 

w1 olalaedt 

•211 50 

2 00 

'° 

• 

I 

I 

I 

I 

I' 

(Pa~must not use this column)