U. W. Form 17. 6-33-10M 
THE UNIVERSITY OF WISCONSIN 
Travel Expense Form 
Use Ink, Indelible Pencil or Typewriter 
See reverse side for travel regulations              Madison, Wis.      Date.Ap
    1.2 .------------- 198 5 
Account of                                                             Address

PURPOSE OF TRIP -_-- e_J                            ........ -------Receipt

Number 
Chiken InvestigtionN m1e 
Fob.    1          Mad son-Frmont                                      0

115 
~90 
It        Frmntfywt                           90                        
                 S 
5 gas 
5      oywtte-a4ossw                   110 
9          L       - En        r120 
13 ga                                         2.%2                      
  1   42~ 
2 oil                                           0252 
10                                               0 
T  a212                                                    1   24 
I   i                                           .26                     
      26 
7 gs                                          1*2             3         
      2 
1 oil 
23          OolaaTepn            =            120 
2 a                                 .01                        1 08 
25          Romat LaCos                                                 
  5            1 0 
142 tenis note for twoptv                   gruse6                      
           7   35 
Total                               6 IT 
A udited  by  ----------------------------------------------- 
Approved -..    .    .   .    .   .    ..--------------------------------------
Div .--  i tU------------------- 
Dept. ------ Ee rum l  a- - - -- - - - --- - - -- - - - - 
Aetivity 
Approved .---------------------------------------------- Class..I     . --
   .........-------- Re  La. . 
Fund-.. -1-5B-_i  ._Ai       -     joY nud3     tio 
STATE OF WISCONSIN, 
s. 
County of ----------------------------    ----------------------------------------------------------.
being duly 
sworn, says that the within account of services and daily expenses amounting
in all to ....---------------------------------- 
dollars, is just, correct and true; that the sums charged were actually disbursed
by him for the State of Wisconsin, as stated in the 
account, and that no part of the same has been paid for. That no part of
the expenses of travel herein charged for has been had upon 
a free pass or free transportation of any nature whatever, and the amount
herein charged as a disbursement for transportation or from 
other expenses incident to travel has been actually paid out. 
Subscribed and sworn to before me this ............... 
day of -----------------------------, A. D. 193 ------ 
Notary Public.