COLUMN C# of SIK Meals

fromColumn A&B

SalesAmount fromColumn A&B

NAME

51

52

53

54

55.

56.

57

58.

59

60

61

62.

63 «

64.

65.

66

67

68

69.

70.

71.

# of SIK Mealsfrom Column

A,B,&C

<*

Grade

Sales Amountfrom Column

A.B.&C

S

MealPeriod

OperatingChargefrom

Column A & BSocial Security

Number

S

Refund Data

NAME Grade MealPeriod

$

SalesAmount

Operating Chargefrom Column

A,E,&C

MealType"

OpChg

S

Amount Refunded

$

$

$

Explanation for Refunds:

*

Signature and Grade of Facility Supervisor

COLUMN D# ofSJK Meals Sales AmountFrom Column From Column

A,B,&C A,B,&C

NAME

72.

73

74.

75.

76

77.

78

79.

80.

81.

82

83

84.

85.

86.

87.

88.

89

90.

91.

92.

Grade

Total All SIX Total DiscountMeals Sate Collected

Total All Cash Collected

Less Refunds

Cash Overages/Shortages

Net Cash for Turn-In

Total Number of •.Cash Meals 1

$

MealPeriod

OperatingCharge FromCol A, R&C

SocialSecurity Number

$

$

TotalOperatingCharge

s

SalesAmount

OpChg

$

$

$

$

3K"fealdays

Explanation of overages/shortages

BASMealdays

Signature and Grade of Person Making Collection

PRIVACY ACT STATEMENTAUTHORITY: 10 U.S.C., Chapter 40; 37 U.S.C., Chapter 9, EO 9397, November 1943PRINCIPAL PURPOSES: Used to authorize and verify the Subsistence-in-Kind entitlement, record the numbers of people subisisting, and account for cash collected.ROUTINE USES: Information maybe disclosed lo the Department of Justice, and to federal, state, local or foreign law enforcement authorities for investigating or presecuting a violation on potention violation of lawDISCLOSURE: Disclosure of SSN is voluntary. However, members otherwise entitled to Subsistence-in-Kind will not be provided a meal at no cost withoul the SSN. since the SSN is used to verify the entitlement.

HEADCOUNT RECORD

ORGANIZATION OR DINING FACILITY

Meal/fflght Meal Rate For Meal Periods Shown(indicate if meals were sold ala carte)

Accounts for meals sold in a dining facility or field Serial No.feeding

DATE

B/L/D/M/R/SALA

$$

t

$

COLUMN A

NAME

1

2

3

4

5.

6

7

8,

9.

10

1 1 .

12

13

14.

15

16.

17

18.

19

20

21.

22.

23.

24

25

Grade MealPeriod

U of SIK Meals Sales Amountfrom from

Column A Column A

Social SecurityNumber

S

* Write in B - Breakfast, L - Lunch, D - Dinner, M - Midnight, R - Brunch, S -40%, Midnight-20 or 40%, Brunch-45%, and Supper-55%.

SalesAmount

OperatingChargefromColumn A

OpChg

$

Operating Charge for Meals Shown(if ala carte, enter percentage)

$

$COLUMN B

* of SIK Meals Sales Amounfrom from

Column A Column A

NAME

26

27.

28

29

30

31

32

33

34

35.

36

37.

38

39

40

41

42.

43

44

45

46.

47

48

49

50

Grade

It of SIK Meals Sales Amountfrom Column from Column

A&B A&B

$

$ Percentage:

$

Operating $Chargefrom

Column AMealPeriod

$

Supper To delermine mealdays, multiply the number of meals served by the appropriate meal percentage

Social SecurityNumber

SalesAmount

OpChg

Operating $Chargefrom

Column A&B

Breakfast - 20%, Lunch-40%, Dinner-

PRIVACY ACT STATEMENTAUTHORITY: 10 U.S.C., Chapter 40; 37 U.S.C., Chapter 9; EO 9397, November 1943PRINCIPAL PURPOSES: Used to authorize and verify the Subsistence-in-Kind entitlement; record the numbers of people subsisting; and account for cash collected.ROUTINE USES: Information may be disclosed to the Department of Justice, and to federal, state, local or foreign law enforcement authorities for investigating or prosecuting a violation or)0tential violation of law.HSCLOSURE: Disclosure of SSN is voluntary. However, members otherwise entitled to Subsistence-in-Kind will not be provided a meal at no cost without the SSN, since the SSN is used toerify the entitlement.

AF Form 79, HeadCOUnt ReCOrd (supersedes previous editions of AFform 79, 1339,463, and 2039)