Blank Officer's Pay Voucher

WAR DEPARTMENT. Form No. 336 WAR DEPARTMENT. Form approved by the Comptroller of Voucher No. the Treasury May 5, 1915 QUARTERMASTER CORPS. OFFICER'S PAY VOUCHER. APPROPRIATION: PAY, ETC., OF THE ARMY, 191 Symbol THE UNITED STATES, To U.S. ARMY. DR. For over years' service. Station , Zone No AMOUNT. OBJECT U.S. SYMBOL. DOLLARS. CTS. NOTATIONS. For pay from , 191 , to ,191 Forpayit Service Pmb due from , 191 to 191 I was suitably mounted at my own expense, and was the actual and exclusive owner of the mount charged for, during the period stated on this voucher, and said mount was maintained at were (Officers imporarily mounted must make the additional certificate required by par. 1273, A. R. 1913.) ARCHIVES 'NATIONAL SERVICE" RECORDS AMD For com. quarters from , 191 ,to 191 For com heat and light for rooms from , 191 to 191 - (Under authority of S. O. No. Hdqrs. , 19 .) Deduct for Insurance S Total ordinary Deduct 4. Bonds leave, of absence. Left, tation 191 , under Deduet or 1259 1/2 AR S. , 191 Dedudt S , 191 Returned to duty TOTAL pay for days' leave of absence, S Balance EXAMINED BY I CERTIFY that the feregoing account is correct that payment therefor has not been received; that I have not been absent on leave, either sick or ordiniry, during t'1e period covere l by this voucher, exceptras above stated and that neither I, my family, nor anyone dependent upon me has occupied public quaters, nor been furnished heat or light by the United States during the period for which commutation is charged. 1 furiher certify that during the period for which commutation of heat and light is charged I actually occupied as quarters at rooms, exclusive of baths, closets, halls pantries and storage rooms, and of parlors, lobbies, dining rooms, sitting rooms, halls and kitchens used in com- mon with other tenants or guests (not guests of officer's family); and that during the period of leave, as stated above, said quarters were occupied actually and exclusively by myself, or self and family, or some one dépendent upon me. (DO NOT sign in duplicate.) Deduction on account of Income Tax, $ Balance of $ paid by check. dated , 191 , on the Treasurer U. S. No. , in favor of for $ No. , in favor of , for $ No. . in favor of , for $ OR (To be completely filled in before signature by payee, and no alle ation or erasure is permitted). Received , 191 of Quartermaster, U. S. A., in cash, Dollars, 100 in full payment of the above account. $ (DO NOT sign in daplicate.) Officer will not sign receipt except when payment is to be made in cash. Fortin et Cle. Nevers-Paris 3100