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O. Box 60000 New Orleans LA 70160 47 ADDITIONAL ADVANCE AMOUNT REPAID Check or Money Order 48 REMAINING ADVANCE BALANCE Block 43 minus Blocks 45 and 47 NET TO TRAVELER AUDITED BY TOTAL DIFFERENCE FORM AD - 616R USDA Rev. 11/96 Clear Form Exception to SF 1012 approved by GSA 11/20/96 TRAVELER S NAME SECTION G -- SCHEDULE OF EXPENSES AND AMOUNTS CLAIMED ITINERARY DATE Month/Day these totals to Section D on STATE Voucher Front..

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