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UCHER PREPARED AT 5. PAID BY (For Use of Paying Office) 6. UNITED STATES, DR., TO (Payee) 7. ADDRESS (Include ZIP Code) 8. FOR EMERGENCY OR EXTRAORDINARY EXPENSE EXPENDITURES UNDER APPROPRIATIONS LISTED BELOW a. FOR EXPENSES INCURRED DURING THE PERIOD (Fill in only if voucher covers reimbursement of funds actually expended.) FROM: TO: b. APPROPRIATION CHARGEABLE c. AMOUNT 0.00 d. TOTAL 9. I CERTIFY THAT THE ABOVE ACCOUNT IS TRUE AND CORRECT; THAT PAYMENT THEREFOR HAS NOT BEEN RECEIVED; A.

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