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DOC 0000017437
Page 55
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t.
REIMBURSEMENT OR PAYMENT
IS HEREBY C
ARE PROPERU CHARGEABLE
TO:
RS
CEH
that the exs«
, with officia
i any source,
aspects.
d/or attached documents were necessa
re,
and that
I
have
not been,
nor wi
this voucher and attachments,
if any
3.
APPROVED;
A.
is mouther ^s^e^ined
?
y «*:
‘hat
such d^athlT
nished wo,
or a sat
i sfactory explanation made
-or the
ur
f
e
r ° [ie,essary official
purposes,
reimbursement or pay-
^nt^fhiM
lhal
SuCh expenditures
are
properly chargeaole
:o
available appropriations as
indicated below.
oate
'
APPROPRIATION
5.
ACKHOWLEDGMEHT OF RECEIPT
_2SH-ia_^
allotment
authorized certifying officer
RECElPl
IS HEREBY ACKNOWLEDGED OF S,
for
the purpose
as stated above.
signatus
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