PUBLIC VOUCHER FOR PURCHASES SERVICES OTHER THAN PERSONAL
Document Type:
Collection:
Document Number (FOIA) /ESDN (CREST):
CIA-RDP64-00360R000400010026-9
Release Decision:
RIPPUB
Original Classification:
K
Document Page Count:
2
Document Creation Date:
November 17, 2016
Document Release Date:
June 29, 1999
Sequence Number:
26
Case Number:
Publication Date:
June 27, 1955
Content Type:
FORM
File:
Attachment | Size |
---|---|
![]() | 89.58 KB |
Body:
Standard FormNo. 108y4-Revised. 1240
Oolaor oiler se neralbU. S. 'UBLIC VOUC E~~j..~~II D. o' Vou-No' .JY
#~((Amen led gar Rele U 1 00400010026
aw Bu. Vou. No.
U.S. _Cost__Reimbursble
(Department, bureau, or establishment) PAID BY
Voucher prepared at _____________________________
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No. ___3__43_______
To
------------------------------------------
-----------------------------------------------------
(Payee)
------------------------
(Address) (City) (Stae
(State)
ARTICLES OR SERVICES
No. and Date of Date of Delivery (Enter description item number of contract or Federal supply
Order or Service schedule, anc~ other information deemed necessary) QUANTITY
Discount Terms
PAYMENT:
Complete ^
Partial ^
Final ^
whipped from to Weight Government B/L No. Total
I certify that the above bill is correct and just and that payment has not been received. (Payee must NOT use this space)
STATINTL
Date --- .
P
Differences
STATINTL
16,514
---------------
---------------
---------------
Amount verified; correct for -----------
(Signature or initials) -----------------------------------------
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
f` Approved Ws ._ ~~ 1+ ?_OO
JKIGINAL Title '-O . ying_Offi
ONLY cer
Title -QO=Itr&C __0ffi Cer - -
Date ------2~r"r
-------------------------------------
STATI NTL THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECUR D WITHOUT WRITTEN AGREEMENT IN ANY FORM
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be shown; other classification optional)
APPROVED:
STATINTL
Approving Officer
Paid by Check No- ------------------------ dated ------------------------------ 19-----, for $-------------------------------------- f on Treasurer of the United States in
favor of payee named above.
--------------
Cash, $---------------------- on ---------------- ---------1 19-----. Payee ---------- l (sign origl-I only)
? When a voucher is signed or receipted in the name of a company or corporation, the name of the person
v rating the company or corporate r as we s t e capacity i P
"John Dee Con y or . i e as 1 1o 1o43 ta~~ c'fAFRcrr6 O3&OR000-40$01-0026.9-------------------
} If the abilit~tdLEiETf(f RTiCRoy~Cd p re eonincd In one person, one signature only is nec-
essa ; otherwise the approving officer will sign on the line below "Approved for $------------------- ", and'
nd Title _____________________________
__________________________
over is oIIlcisl title,
Standard Form No. 1086-Revised
Cc ormpresedbed for Release 0Y qhexI Ft[ 400010026-9
1(den. Reg. No. 81, 8upp. No. 11) `'Services Other Than Person
CONTINUATION SHEET
U. S. __~=ost Reimbursable- ----------------------------------------------- Sheet No. ----] ------ of Bureau Voucher No. _25.
------- --------------------
(Department, bureau, or establishment)
No. and Date
of Order
ARTICLES OR SERVICES
(Enter description, Item number of contract or Federal supply schedule,
and other information deemed necessary)
6-12-55.
Contract A101 for the period 6-6-55 thru
Direct Labor Costs properly chargeable to
SYSTEM 1 CONFIDENTIAL PAYROLL
Approved For Release 2000/04Eo4B1Ma5CJA RDP64, 360R0