Final Personnel Record for Newhouse, Delbert C., U.S. Navy, 1957

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DA:rA SHEET TO ACCOMPANY CLAI~OR ­
REI..SEMENT FOR DEPENDENTS'~VEL
(All entries to be made by the claimant in his own handwriting)
ents;he following data is subj;d;;
reimbursement for travel performed by my depend­
ubs~i~;f my clai~~for
MEMBER'S FULL NAME / ~
---~-!
______ ______________/ _Zz~_'F'__J______r;:__~__t?__--:_t_
(First)
(Middle)
7
(Last)
(Service number)
(Ranlc/rate)
ADDRESS TO WHICH CHECK IS TO BE MAILED: --------------------------------------------------------------------------------------­
WIFE'S NAME: --~----J~----~----------------------------------------------­
*CHILDREN'S NAMES:
RELATIONSHIP
DATE OF BIRTH
___/ ~ ~ ---~----~---------------------¼-~,!_?:_ ____
______Q /1-v1'1L-~--~----£k..~__________3/4~Q______ _
------------------------------------------------------------------------------------·----------------·--------------------------------------·-----------------------------­
*Step children or adopted children must be classified as such. Dependent parent must be classified and claimed as such.
"I certify that my dependents were located at (Street address, city, and State)-3:[_fL___JE__~-~­
R~--/---(!)/J.L~------------------ wh~ ocdm <licecting d,taohm,nt from my old p•rman~t station
were received and departed that place on (Date) __
f ______________ ; and arrived at (Street address, city, and
2/1_u~__
State) 2J~_~_f_J__Tj __ -
_"
-----
-J---ef~-------, on (Date) _
G________ ;
3-/4/6-___
that such travel was performed at my own expense, nd that the travel covered by this claim represents the entire travel
of all my dependents which has been or will be made on this change of station except as follows: (Exception, if any)
If orders direct my travel overseas where dependents are not permitted to go, I HEREBY DESIGNATE (Street ad­
dress, city, and State) ----··-------··-----------··------------------------------------------------------------------------------------------------------­
as point to which transportation of dependents is desired.
I certify that my dependents were last transported or reimbursed at Government expense for travel to _____________________
_______________(Pen~/@~ --------------------------------- -------- ----- ------------------ ---"
NOTE.-This data sheet is to be presented to the disbursing officer with the original and three certified copies of travel
orders, with all endorsements. The "Voucher for Reimbursement for Expenses Incident to Dependent Travel"
(NAV. S. AND A. FORM 912 Rev.) will be signed when completely filled in. This "Data Sheet" or the "Voucher
for Reimbursement for Expenses Incident to Dependents Travel" (NAV. S. AND A. FORM 912 Rev.) will not be
signed in blank.
"I further certify that all entries made above are in my own handwriting and are true and correct; that I have
read this completed data sheet and understand that any misrepresentation or concealment of material fact by me
may work a forfeiture of the claim and subject me to trial by court martial or Federal District court and to penal­
ties extending to 5 years imprisonment or $10,000 fine, or both."
NAV. S. AND A. FORM 915 (4-53)
U. S, GOVERNMENT PRINTING OFflCE
l G-68710-1
p:¾........,,,___c