TRAVEL VOUCHER OR SUBVOUCHER
Read Privacy Act Statement, Penalty Statement, and Instructions
on back before completing form.
Use typewriter, ink, or ball point
1. PAYMENT
pen.
PRESS HARD.
DO
NOT use pencil.
If more space is needed,
Split Disbursement: Amount to Government
Electronic Fund Transfer (EFT)
continue in remarks.
Travel Charge Card
$
Payment by Check
2. NAME (Last, First, Middle Initial) (Print or type)
3. GRADE
4. SSN
5. TYPE OF PAYMENT (X as applicable)
Member/Employee
TDY
6. ADDRESS. a. NUMBER AND STREET
b. CITY
c. STATE
d. ZIP CODE
PCS
Other
Dependent(s)
DLA
e. E-MAIL ADDRESS
10.
FOR D.O. USE ONLY
7. DAYTIME TELEPHONE NUMBER &
9.
PREVIOUS
GOVERNMENT PAYMENTS/
8. TRAVEL ORDER NUMBER
a. D.O. VOUCHER NUMBER
AREA CODE
ADVANCES
11. ORGANIZATION AND STATION
b.
SUBVOUCHER
NUMBER
13. DEPENDENTS' ADDRESS ON RECEIPT OF
c. PAID BY
12. DEPENDENT(S) (X and complete as applicable)
ORDERS (Include Zip Code)
ACCOMPANIED
UNACCOMPANIED
c. DATE OF BIRTH
a. NAME (Last, First, Middle Initial)
b. RELATIONSHIP
OR MARRIAGE
14. HAVE HOUSEHOLD GOODS BEEN SHIPPED?
d.
COMPUTATIONS
(X one)
YES
NO (Explain in Remarks)
c.
d.
15. ITINERARY
e.
f.
MEANS/
REASON
LODGING
POC
a. DATE
b. PLACE (Home, Office, Base, Activity, City and State;
MODE OF
FOR
COST
MILES
City and Country, etc.)
TRAVEL
STOP
DEP
ARR
DEP
ARR
DEP
ARR
DEP
ARR
DEP
ARR
DEP
e. SUMMARY OF PAYMENT
ARR
(1)
Per
Diem
DEP
(2)
Actual
Expense Allowance
ARR
(3)
Mileage
16. POC TRAVEL (X one)
OWN/OPERATE
PASSENGER
17. DURATION OF TDY TRAVEL
(4)
Dependent
Travel
18. REIMBURSABLE EXPENSES
(5)
DLA
12 HOURS OR LESS
a. DATE
b. NATURE OF EXPENSE
c. AMOUNT
d. ALLOWED
(6)
Reimbursable
Expenses
(7)
Total
MORE THAN 12 HOURS
BUT 24 HOURS OR LESS
(8)
Less
Advance
(9)
Amount Owed
MORE THAN 24 HOURS
(10) Amount Due
19. GOVERNMENT/DEDUCTIBLE MEALS
a. DATE
b.
NO.
OF MEALS
a. DATE
b.
NO.
OF MEALS
b. DATE
d. DATE
20.a. CLAIMANT SIGNATURE
c. SUPERVISOR SIGNATURE
b. DATE
21.a. APPROVING OFFICER SIGNATURE
22. ACCOUNTING CLASSIFICATION
23. COLLECTION DATA
26. TRAVEL ORDER
24. COMPUTED BY
25. AUDITED BY
27. RECEIVED (Payee Signature and Date or Check No.)
28. AMOUNT PAID
POSTED BY
DD FORM 1351-2, JUL 2002
PREVIOUS EDITION IS OBSOLETE.
Exception to SF 1012 approved by GSA/IRMS 12-91.
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