Officer's Pay Voucher, Blank

WAR DEPARTMENT. Form No. 336. WAR DEPARTMENT Form approved by the Comptroller Voucher No. of 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. NOTATIONS. DOLLARS. CTS. For pay from 191 , to , 191 For pay for mount from , 191 , to , 191 I was suitably mounted at my own expense, and was the actual and exclusive owner mission of the mount charged for, during the period stated on this voucher, and said mount was were } maintained at ARCHIVES AND 'NATIDITAL RECORDS (Officers temporarily mounted must make the additional certificates required by par. 1273, A. R., 1913.) SERVICE For com. quarters from 191 to , 191 For com. heat and light for rooms from 191 to 191 (Under authority of S. o. No. Hdqra 19 ) Total On { ordinary leave of absence. Left station , 191 , under sick . S. o. No. Hdqrs , 191 Extended by S. o. No Hdqrs , 191 Returned to duty , 191 Deduct half pay for days' leave of absence, Balance EXAMINED BY I CERTIFY that the foregoing account is correct; that payment therefor has not been received; that I have not been absent on leave, either sick or ordinary, during the period covered by this voucher, except as above stated; and that neither I, my family, nor anyone dependent upon me has occupied public quarters, nor been furnished heat or light by the United States during the period for which commutation is charged. I further certify that during the period for which commutation of heat and light is charged I actually oc- cupied 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 common 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 dependent 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 alteration or erasure is permitted.) Received , I9I , of Quartermaster, U. S. A., in cash Dollars, in full payment of the above account. 100 $ (DO NOT sign in duplicate.) Officer will not sign receipt except when payment is to be made in cash.