Encl (6) to COMDTINST 16477.5
Voucher No.___________
Schedule No.___________
PUBLIC VOUCHER
FOR "QRP" RECYCLING REFUNDS
U.S.C.G. *______________________________________________
Location: *_____________________________________________
_____________________________________________
Paid by
Appropriation or Fund *_________________________________
NAME/ADDRESS TO FORWARD REFUND
To:
Address:
Deposit received from the above-named depositor on *_______, 19___ for
*__________________________________________ has been applied as herein stated and the
balance indicated is returned herewith:
Amount of deposit......................... $ _______________
Credited to QRP unit OE/AFC Account............ $__________
Balance authorized to be refunded to MWR.... $_______________
* TO BE COMPETED BY FINCEN
(Sign original __________________________
only)
(Authorizing Signature)
Title______________________________________
Refund {Check No. ______________________________
by {
{Cash, $ _______________________________
{
{Other method, $ ___________________________________________
(Describe)
DEPT. OF TRANSP., USCG, CG-5579 (2-94)
LOCAL REPRO
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