General Services Administration Form 789: Statement, Voucher, and Schedule of Withdrawals and Credits1974-01-01unknownhttp://rightsstatements.org/vocab/NKC/1.0/enghttp://congressarchives.org/record/CAC_CC_109_4_22_20_0018This is a form for a statement, voucher, and schedule of withdrawals and credits to be sent to the General Services Administration. It includes information about payments made by a member of the United States House of Representatives and details of charges for various items. The total amount due on the statement is $126.99 and adjustments may appear on subsequent statements. The form also includes a certification from the paying office.