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download dd 1351-2 fillable pdfRead 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
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.
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
2. NAME (Last, First, Middle Initial) (Print or type)
Doe, John M.
6. ADDRESS. a. NUMBER AND STREET
123 Main Street
d. ZIP CODE
e. E-MAIL ADDRESS
7. DAYTIME TELEPHONE NUMBER &
5. TYPE OF PAYMENT (X as applicable)
10. FOR D.O. USE ONLY
8. TRAVEL ORDER/AUTHORIZATION
9. PREVIOUS GOVERNMENT PAYMENTS/
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)
a. NAME (Last, First, Middle Initial)
Doe, Jane T.
c. DATE OF BIRTH
c. PAID BY
123 American Way, Columbus,
14. HAVE HOUSEHOLD GOODS BEEN SHIPPED? d. COMPUTATIONS
NO (Explain in Remarks)
b. PLACE (Home, Office, Base, Activity, City and State;
City and Country, etc.)