PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400010005-2
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 17, 2016
• Document Release Date: June 29, 1999
• Sequence Number: 5
• Publication Date: July 19, 1955
• Content Type: FORM

b1 V- V, UVjJJ , Vd. J.
Stanr3tt F PT,gm, visn3 D.
______
oo~ tr e e a , or Release j(@W0MRgWFP0F *Wfi1QR 0480 o0 =2
eptember7, 1960 arntnnr.r nmrmn TTTk T TIT,
.ne?nT.T5It
-
(Amenuo(l February 20, 1952)
U. S. __Qast__Re mtzzir_sab1 -.----------------------------------- -------------------------------------- ----------
(Department, bureau, or establishment)
Voucher prepared at ------------- --....--------------------------------------------------------------------------------------
THE UNITED STATES, Dr.,
(Give place and date)
Payee's Account No. _37-3 -------
To --------------------- ------=----------------------------------------------------------------------------------------
(Payee)
---------------------------??------------------------------------------------------------------- ---------------------------------
(Address) (City) (State)
---------------------------------------------- --------------- -----
----------------------------------------------- --------------- -----
-------------------------------------------- -- --------------- -----
No. and Date of
Date of Delivery
ARTICLES OR SERVICES
(Enter description Item number of contract or Federal supply
UANTITY
UNIT PRICE
AMOUNT
Order
or Service
schedule, and other information doomed necessary)
Q
Cost
Per
Dollars
Cts.
Discount Terina
Cost
$5,154.
7
PAYMENT:
Complete
Partial ^
Final [J
Use continuation sheet(s) if necessary
Shipped from to Weight Government B/L No.
Total
she
7
(Payee must NOT use this space)
I certify that the above bill is correct and just and that payment has not been received.
Differences --------------------------------
---------------
-----
STATI NTL (Sign original only)
Date STATINTL
-- ---- ------- -----------
roa
Amount verified; correct for _- ---------
A-5,
7
.+#j,44 `v` ----------
SIGN
ORIGINAL
ONLY
- Officer-- ---------STATINTL
Title --- Contracting?
----------- ---
-
(Signature or initials) __-___-___-______-_
Date Invoice Recd.
Date ------------------------------------------------------------ -------------
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
STATINTL
States in
Check No. J (_~Q~_ '9 J___ dated _,6d __`~_ ---------- 19 '-or for $SSO -1___Fz__a a__ ___________ fon Treasurer
payee of the named United
(( ~J {
ove.
Paid by
Cash, $------------------------, on --------------- 19-----. Payee -----------------------
-------------------------------------------------
? When a voucher is signed or receipted in the name of a company or corporation, the name of the person
writing the company or corporate name., as well as the capacity in which he signs, must aplpear. For example:
"John Doe Company, per John Smith, Secretary", or ' Treasurer", as the ease may be.
pIf the abil y two ~(nrl~y~ry~,~gy~iy} o o~e+$~ to e
essary; otherlbCii~oliCfIITei~lltpQfiaRAeA/1PJ,tlY1N7fdfe4 filr-~1-[~ V
ever hfs official ti e.
Per -?----------------- ---------------------------------------
036bP
0004DOM40005-4----------------------
1G 22900-5
 Standard Form. No. 103-Revised
swF9iAlpl Grimm Nr__ n. __. i~i~rrww.~aaty~# 11 - ~w~tife~aw?ar ne~Thwnnnwnnnr ri
(Gen. Reg- No. 51, bupp. No.11) Services Other I han t'ersonal
CONTINUATION SHEET
U . S . ---.Oos?.--RRimburs.able-------------------------------- ----------------------------- Sheet N o ---- of Bureau Voucher No. --- 6 -----
Date of
ARTICLES OR SERVICES
QUAN-
UNIT PRICE
AMOUNT
No. and Data
Delivery
(Enter description, item number contract or Federal supply schedule,
1TY
of Order
or Service
and other information deemed necessary)
Cost
Per
Dollars
Cts.
CONFIDEN IAL PAYROLL SYSTEM 3
Direct Labor Costs properly chargeable to
Contract AlOl for the period 6/27/55 thru
7/3/55.
STATIN
L
Week Ending 7/3/55.
STATIN
L
Overhead com uted at interim rate
of
l
777
STATINTL
Approved or a ease s a E,;? IAmRDR64 AOa60R000400010005-2