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COST [[?---?]] DATA - PERSONAL
(Indicate costs in U.S. Dollars)

REPORT CONTROL SYMBOL  JTR-1001

(Information contained hereon is for use in connection with overseas station allowance and will not be used for any other purpose)

LAST NAME - FIRST NAME - MIDDLE INITIAL
^[[Davis, Benjamin O.]]
GRADE, RANK OR RATE ^[[Brig. Gen]]
SERVICE NUMBER ^[[1206A]]
ORGANIZATION ^[[Air Task Force 13P]]
LENGTH OF TIME YOU HAVE BEEN IN THIS AREA
YEARS ^[0]  MONTHS ^[6]
CONTEMPLATED LENGTH OF PRESENT TOUR OF DUTY AT THIS STATION
YEARS [0]  MONTHS [?]
LOCATION OF DUTY STATION CITY ^[[Taipei]]
COUNTRY ^[[Taiwan]]   
LOCATION OF RESIDENCE OVERSEAS
CITY ^[[Taipei]]  COUNTRY ^[[Taiwan]]
LENGTH OF RESIDENCE AT THIS ADDRESS
YEARS ^[0]  MONTHS [6]

1. DEPENDENTS
a. NUMBER OF DEPENDENTS RESIDING WITH YOU IN THE VICINITY OF YOUR DUTY STATION
UNDER 12 YEARS OF AGE [blank line]
12 YEARS OF AGE OR OLDER [blank line]
b. NUMBER OF DEPENDENTS RESIDING ELSEWHERE
UNDER 12 YEARS OF AGE [blank line]
12 YEARS OF AGE OR OLDER [blank line]

2. SERVANTS
[[9 column list]]
a. FULL TIME TYPE (e.g., Cook, Main, Gardener, Laundress, etc.)(1) | NUMBER (2) |
HOURS WORKED MONTHLY (3) | CASH WAGES PAID SERVANTS MONTHLY (4) | COST OF MEALS FURNISHED SERVANTS MONTHLY (5) | COST OF UNIFORMS FURNISHED SERVANTS MONTHLY (6) | COST OF INSURANCE FOR SERVANTS MONTHLY (7) | COST OF MEDICAL CARE FOR SERVANTS MONTHLY (8) | OTHER COSTS OF SERVANTS MONTHLY (9)

^[[Maid]] | 1 | 170 | $20.60 | — | $1.00 | — 
 — | —

^[[Cook]] | 1 | 170 | $38.00 | — | $1.00 | — | — | —

2. SERVANTS PART TIME [blank]

c. DO SERVANTS EAT THE SAME FOOD AS THE FAMILY? [x] YES   [ ] NO
d. REMARKS (Explain here the costs included in columns (6),(7),(8), and (9) of Items a and b above)  [blank]

3. SUBSISTENCE
a. AVERAGE MONTHLY FOOD COSTS [[footnote 1]]
   AT HOME $ ^[[?]]
   AT RESTAURANTS OR OTHER SIMILAR ESTABLISHMENTS ^[[?]]
b. IS A U.S. MILITARY COMMISSARY AVAILABLE?
   [ ] YES  [X] NO - IF "YES" STATE APPROXIMATE PERCENT OF TOTAL FOOD YOU PURCHASE THEREIN [blank line] %
c. IS A STATE DEPARTMENT COMMISSARY AVAILABLE? [X] YES  [ ] NO - IF "YES" STATE APPROXIMATE PERCENT OF TOTAL FOOD YOU PURCHASE THEREIN [blank line] %
REMARKS [blank]

[[footnote 1]] Include costs for yourself, your dependents, and your servants (if any). Do NOT include cost of food purchased away from home while in a travel status. Do NOT include cost of food for entertainment or for members of your family not residing in the vicinity of your duty station.
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DD FORM 376 1 OCT 52  PREVIOUS EDITIONS OF THIS FORM ARE OBSOLETE.
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