Form Ao 1012 - Travel Voucher - 2011
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1
2Open Instructions
AO 1012 (Rev. 01/11)
TRAVEL VOUCHER
2. TYPE OF TRAVEL
3. VOUCHER NUMBER
1. OFFICE OR COURT UNIT
TEMPORARY DUTY
PERMANENT CHANGE
OF STATION
a. NAME (Last, first, middle initial)
b. SOCIAL SECURITY NO.
5. PERIOD OF TRAVEL
a. FROM
b. TO
,
,
c. MAILING ADDRESS (Include ZIP Code)
d. OFFICE TELEPHONE NO.
6. TRAVEL AUTHORIZATION
a. NUMBER(S)
b. DATE(S)
e. PRESENT DUTY STATION
f. RESIDENCE (City and State)
7. TRAVEL ADVANCE
8. OPTIONAL USE
e. What are the numbers of the travel advances
a. Total of all Outstanding Advances
being repaid at this time?
b. Amount to be applied for this trip
c. Amount Repaid Government
Attached:
Check
Cash
d. Balance Outstanding
Travel Advance Numbers
$0.00
This information will be provided by the finance office.
9. TRANSPORTATION
I hereby assign to the United States any right I may have against any parties in connection with reimbursable transportation charges
described below, purchased under cash payment procedures (FPMR 101-7).
TICKETS
POINTS OF TRAVEL
AMOUNT
List by number below and
AMOUNT
CHARGED TO GTA
attach passenger coupon.
DATE
TOTAL
PAID BY
(Centrally Billed
If paid by the traveler show
ISSUED
COST
TRAVELER
Account)
FROM
TO
claim on the reverse side.
a.
b.
c.
d.
e.
f.
10. I certify that the purpose of this trip was official business 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 travel expenses
claimed on this voucher.
TRAVELER
AMOUNT
SIGN HERE
DATE
$
CLAIMED
0.00
NOTE: Falsification of an item on an expense account causes a forfeiture of claim (28 U.S.C. 2514) and may result in a fine of not more
than $10,000 or imprisonment for not more than 5 years or both (18 U.S.C. 287; i.d. 1001).
13. FOR FINANCE OFFICE USE ONLY
11. I have reviewed this travel voucher and the expenses claimed appear
reasonable and in compliance with the judiciary supporting personnel
0.00
a. DIFFERENCES
travel policies.
IF ANY (Explain
VOUCHER
and show
amount)
REVIEWER
SIGN HERE
DATE
12. I approve the business purpose of this trip(s) and reimbursement for the
b. TOTAL VERIFIED CORRECT FOR
amount claimed appears reasonable.
CHARGE TO APPROPRIATION
$
0.00
APPROVING
OFFICIAL
c. APPLIED TO TRAVEL ADVANCES
DATE
SIGN HERE
$
d. NET TO TRAVELER
0.00
14.
FY
FUND
BUD ORG
COST ORG
PROGRAM
BOC
SUB 02
SUB 03
SUB 04
SUB 05
ACCOUNTING
0.00
0.00
0.00
0.00
CLASSIFICATION:
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