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[[preprinted]] 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. [[line]] DD FORM 376 1 OCT 52 PREVIOUS EDITIONS OF THIS FORM ARE OBSOLETE. [[preprinted]]