Technical Exhibit 3b.pdf

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Date:

VENDOR:

FOR OFFICIAL USE ONLY

APPLICANT MEAL/LODGING AUTHORIZATION

AND RECEIPT VOUCHER FOR LATE ARRIVAL ADD-ONS

(For use of th is form, see USMEPCOM Reg 715-4)

(See reverse side for instructions)

KIND OF SERVICE

LODGING: "LS" SINGLE MEAL: "S" SUPPER "L" LUNCH

"LD" DOUBLE "B" BREAKFAST

NAME

(LAST, FIRST, MI) SSN

ARRIVAL

DATE HOUR

MILITARY

SERVICE

KIND OF

SERVICE

APPLICANT/

ENLISTEE

A E

APPROVAL RECEIVED FROM:

NAME AND TITLE OF MEPS/RCTG OFFICIAL

OR APPLICANT RECORDS

SIGNATURE OF APPLICANT RECEIVING

SERVICE

PRICE OF

THE MEAL

DATE

RECEIVED OR

ROOM NUMBER

CERTIFIED CORRECT

ARMY COUNSELOR

ARMY NATIONAL GUARD COUNSELOR

AF LIAISON REP

NAVY LIAISON REP

MARINE LIAISON REP

SIGNATURE DATE

USMEPCOM FORM 728-E, DEC 2004

I certify that the above services were rendered as authorized by officials who name/title are listed above or by records in the appl icants possession as described by form number above.

SIGNATURE AND TITLE (VENDOR OR REPRESENTATIVES) DATE

Replaces USMEPCOM Form 728, 1 Feb 88 which is obsolete

P A G E OF P AG ES

OTHER

terri.corbett Typewritten Text

TECHNICAL EXHIBIT 3B

terri.corbett Typewritten Text

INSTRUCTIONS FOR COMPLETION

COLUMN ENTRY

DATE THE DATE THE FORM IS PREPARED.

VENDOR THE NAME OF CONTRACT ESTABLISHMENT.

N A ME

S S N

ARRIVAL INFORMATION DATE

HOUR

MILITARY SERVICE

KIND OF SERVICE

REQUIRE A SEPARATE LINE ENTRY.

APPLICANT/ENLISTEE ENTER "X" IN APPLICANT BLOCK IF NOT SWORN IN.

ENTER "X" IN ENLISTEE BLOCK IF SWORN IN.

APPROVAL RECEIVED LIST INFORMATION AS APPROPRIATE. EXAMPLE:

FROM (NAME & TITLE

OF MEPS/RECRUITING (1) JOHN SMITH

OFFICIAL OR APPLICANT MEPS BUS DRIVER

RECORDS) (2) NAME OF AUTHORIZING RECRUITING OFFICIAL

(3) APPLICANT RECORDS

DD FORM 4, AND SOCIAL SECURITY CARD

SIGNATURE OF APPLICANT OBTAIN THE SIGNATURE OF THE INDIVIDUAL RECEIVING THE SERVICE.

RECEIVING SERVICE

PRICE OF MEAL

USMEPCOM FORM 728-E, DEC 2004 Replace USMEPCOM Form 728, 1 Feb 88 which is obsolete

PRINT (OR TYPE) THE NAME (LAST, FIRST, MIDDLE INITIAL) OF ALL THE INDIVIDUAL RECEIVING THE SERVICE. A SEPARATE LINE WILL BE USED FOR EACH SERVICE SUPPLIED AN INDIVIDUAL.

THE SOCIAL SECURITY NUMBER ASSIGNED TO THE APPLICANT. IF THE APPLICANT DOES NOT

HAVE AN ASSIGNED SSN, ENTER NONE."

ENTER THE DATE (DAY AND MONTH) APPLICANT ARRIVED AT CONTRACT ESTABLISHMENT.

EXAMPLE: 1 JUN 87.

TIME THAT THE APPLICANT ARRIVED AT CONTRACT ESTABLISHMENT REQUESTING THE SERVICE.

EXAMPLE: 7 :00 PM.

ENTER APPROPRIATE MILITARY SERVICE (ARMY, NAVY, AIR FORCE, MARINE CORPS) FOR WHICH

THE APPLICANT IS TO BE PROCESSED.

SHOW THE TYPE OF SERVICE BEING PROVIDED. LODGINGS: "LS" FOR SINGLE, "LD" FOR DOUBLE, "S" FOR SUPPER, AND "B" FOR BREAKFAST. EACH SERVICE FURNISHED AN INDIVIDUAL WILL

FOR THOSE VENDORS WHO FURNISH MEALS UNDER CONTRACT THAT CALL FOR REIMBURSEMENT

OF THE FOOD AND BEVERAGE (NON-ALCOHOLIC) TAKEN, VENDOR WILL ENTER THE ACTUAL COST

OF ITEMS TAKEN , UP TO THE CONTRACTUAL DOLLAR CEILING OF THE MEAL, AFTER HIS/HER

SIGNATURE.

terri.corbett Typewritten Text Technical Exhibit 2B (continued) terri.corbett Typewritten Text terri.corbett Typewritten Text terri.corbett Typewritten Text terri.corbett Typewritten Text terri.corbett Typewritten Text terri.corbett Typewritten Text terri.corbett Typewritten Text terri.corbett Typewritten Text