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download dd 1351-2 fillable pdf

Read Privacy Act Statement, Penalty Statement, and Instructions on back before completing
form. Use typewriter, ink, or ball point pen. PRESS HARD. DO NOT use pencil. If more space
is needed, continue in remarks.
TRAVEL VOUCHER OR SUBVOUCHER
1. PAYMENT
SPLIT DISBURSEMENT: The Paying Office will pay directly to the Government Travel Charge Card (GTCC) contractor the portion of your reimbursement representing travel charges for transportation, lodging, and rental car if you are a civilian employee, unless you elect a different amount. Military personnel are required to
designate a payment that equals the total of their outstanding government travel card balance to the GTCC contractor.
Electronic Fund
Transfer (EFT)
NOTE: A split disbursement is only necessary when a GTCC is used while on official travel for the Government.
$
Pay the following amount of this reimbursement directly to the Government Travel Charge Card contractor:
Payment by Check
3. GRADE
2. NAME (Last, First, Middle Initial) (Print or type)
Doe, John M.
4. SSN
GS-11
b. CITY
6. ADDRESS. a. NUMBER AND STREET
c. STATE
123 Main Street
000-00-0000
TDY
Member/Employee
d. ZIP CODE
PCS
Other
Dependent(s)
DLA
NY
Rome
13441
[email protected]
e. E-MAIL ADDRESS
7. DAYTIME TELEPHONE NUMBER &
AREA CODE
100.00
5. TYPE OF PAYMENT (X as applicable)
10. FOR D.O. USE ONLY
8. TRAVEL ORDER/AUTHORIZATION
NUMBER
555-555-5555
9. PREVIOUS GOVERNMENT PAYMENTS/
ADVANCES
PC43760
0.00
a. D.O. VOUCHER NUMBER
b. SUBVOUCHER NUMBER
11. ORGANIZATION AND STATION
DFAS Rome, NY 13441
13. DEPENDENTS' ADDRESS ON RECEIPT OF
ORDERS (Include Zip Code)
12. DEPENDENT(S) (X and complete as applicable)
UNACCOMPANIED
ACCOMPANIED
a. NAME (Last, First, Middle Initial)
b. RELATIONSHIP
Doe, Jane T.
15. ITINERARY
a. DATE
2016
6/10
6/10
6/11
6/11
DEP
ARR
DEP
ARR
DEP
Wife
c. DATE OF BIRTH
OR MARRIAGE
c. PAID BY
123 American Way, Columbus,
OH 43213
20130927
14. HAVE HOUSEHOLD GOODS BEEN SHIPPED? d. COMPUTATIONS
(X one)
NO (Explain in Remarks)
YES
c.
d.
e.
f.
MEANS/ REASON
LODGING
POC
MODE OF
FOR
COST
MILES
TRAVEL
STOP
b. PLACE (Home, Office, Base, Activity, City and State;
City and Country, etc.)
Columbus, OH
PA
AD