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STANDARD FORM 1012
"August 1970
Title 7, GAO Manual
TRAVEL VOUCHER
1012-113
DEPARTMENT, BUREAU, OR ESTABLISHMENT
VOUCHER NO.
DHEW-NIH-NCI-DCCP
PAYEE'S NAME
Dr. William Darby
SS# 414-50-9489
SCHEDULE NO.
MAILING ADDRESS ( Including ZIP Code)
PAID BY
Nutrition Foundation
489 5th Avenue
New York, New York
OFFICIAL DUTY STATION
RESIDENCE
New York, New York
FOR TRAVEL AND OTHER EXPENSES
TRAVEL ADVANCE
CHECK NO.
FROM (DATE)
TO ( DATE)
6/10/76
6/11/76
Outstanding
APPLICABLE TRAVEL AUTHORIZATION (S)
CASH PAYMENT OF $-
Amount to be applied
RECEIVED (DATE)
NO
DAT
NIH-160284
6/14/76
Balance to remain
outstanding
(Signature of Payee)
TRANSPORTATION REQUESTS ISSUED
TRANSPORTATION
AGENT'S
INITIALS OF
MODE, CLASS
POINTS OF TRAVEL
REQUEST NUMBER
VALUATION
CARRIER
OF SERVICE,
OF TICKET
ISSUING
DATE
TICKET
AND ACCOM-
ISSUED
MODATIONS
FROM-
TO-
.. Certified correct. Payment or credit has not been received.
*/ hou. 1976
AMOUNT
Dollars
Cts
(Date)
151 25
Approved. Long distance telephone calls are certified as necessary in the |DIFFERENCES:
interest of the Government.
Administrative Officer, DCCP, NCI
( Date)
* **(Approving Officer)
NEXT PREVIOUS VOUCHER PAID UNDER SAME TRAVEL AUTHORITY
VOUCHER NO.
D.O. SYMBOL
DATE ( MONTH-YEAR.)
Total verified correct for charge to appropriation (s)
(initials) -
Certified correct and proper for payment:
Applied to travel advance (appropriation symbol)
NET TO
(Date)
( Authorized Certifying Officer)
TRAVELER
ACCOUNTING CLASSIFICATION
6-8322561 T
212M
Abbreviations for Pullman accommodations: MR, master room; DR, drawing room; CP, compartment; BR, bedroom; DSR, duplex single room; RM, roomette;
DRM, duplex roomette; SOS, single occupancy section; LB, lower berth; UB, upper berth; LB-UB, lower and upper berth; S. seat.
than $10,000 or imprisonme
*FRAUDULENT CLAIM-Falsification of an item in an expense account works a forfeiture of the claim (28 U.S.C. 2514) and may result in a fine of not more
imprisonment for not more than 5 years or both (18 U.S.C. 287; id. 1001).
(31 U.S.C. 680a).
*If long distance telephone calls are included, the approving officer must have been authorized in writing by the head of the department or agency to so certify

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