Fill and Sign the Optional Form 1012 Travel Voucher Gsagov

TR 1. OFFICE OR COU UNIT 2 TYPE .AO 1012 (Rev. 11/06) TEMPORAR PERMANENT CHANGEOF ST 3. 4 a. NAME , , b. SOCIAL SECURITY NO. 5 PERIOD c. a. FROM b. T 6 TR a. NUMBER(S) bD e. f 7 TR a. T This information will be provided by the finance office. b. Amount to be applied for this trip c. Att Check Cash d. Balance Outst e. What are the numbers of the travel advancesbeing T 1 FY 1 FOR FINANCE OFFICE USE ON a. DIFFERENCESIF ANYand showamount) b. TOTAL VERIFIED CORRECT FORCHARGE T c. APPLIED T d. NET 1 I have reviewed this travel voucher and the expenses claimed appear reasonable and in compliance with the judiciary supporting p ersonnel travel policies. VOUCHERREVIEWERSIGN HERE DA DA 1 I approve the business purpose of this trip(s) and reimburse ment for the amount claimed appears reasonable. APPROVINGOFFICIALSIGN HERE NOTE: Falsification of an than $10,000 or imprisonment for not more than 5 years or bo th (18 U.S.C. 287; i.d. 1001). 10. I certify that the purpose of this trip was official busines s and, further, that this claim for reimbursement of travel expenses is true and correct to the best of my knowledge and belief; further, I have not received any other payment or credit for the tra vel expenses claimed on this voucher TRASIGN HERE AMOUNTCLAIMED FROM e. TO f I hereby assign to the United described below POINTS OF TRA AMOUNT CHARGED T(Centrally Billed Acc d 9 TRANSPOR TICKETS AMOUNTPTRA c TCOST b DAISSUED a $ $ $ DA ACCOUNTINGCLASSIFICA 8 OPTIONAL USE If paid by the traveler showclaim on the reverse side. List by number below andatt d OFFICE Col. If the voucher includes perdiem allowances for membersof employee's immediatefamily, show members' names,ages and relationship toemployee and martial statusof children (unless information is shown on the travelauthorization.) See Guide , Vol 1, CH VI for more information. DA TIME(Hour and am/pm) DESCRIPTION (Depardiem computation, or other e MEALS ITEMIZED SUBSISTENCE EXPENSES SCHEDULE OF EXPENSES AND AMOUNTS CLAIMED Complete onlyfor actualexpense travel Col. (d-f) (g)(h) (i) (m) (n) Show other expenses such as local transportation (fares for bus, taxi, limousine, or subway, etc.) offical telephone calls, baggage handling, car rental, or relocation expenses other than subsistence. INSTR BREAK-FAST LUNCH TOT MISC.SUBSIS-TENCE LODGING TOT SUBSISTENCEEXPENSE MILEAGERATE: NO. OFMILES MILEAGE TRA TRA PA OF Completeinf this is a contin sheet. AMOUNT CLAIMED SUBTOTALS If additional space is required, contiEnter gr and (n), bel front of this f TOTAL AMOUNT CLAIMED TOTALS (a) PA (j) Show amount incurred for each meal, including taxes and tips , relating to the meal being itemized.By calendar day, total the daily cost of meals.By calendar day, show the daily cost of incidentals, such as tips for maid services, forgotten items (eg., toothbrush), etc.Show the daily lodging cost excluding taxes for claims under actual expense method or per diem method. Show locality per deim amount or total of lodging plus M & I E rate if required by authorization, or total of actual expenses not t o exceed the applicable maximum rates. Show total subsistence expense incurred for actual expense t ravel. DINNER (Unlisted items are self-e