PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400030010-4
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 11, 2016
• Document Release Date: April 8, 1999
• Sequence Number: 10
• Publication Date: November 2, 1955
• Content Type: FORM

D. O. Vou. No- -------------------------------
Standard Form No. 1034-Revised .Fopttoner Gcerlbnea,( d~ ~itized - Ap$'rl W(~Ci69(#Affiff~A&%WN,03?01o
C7omriler
0qQ40 0010-4
u.
September 7 19 0No III U.
T 51 ~u
T
A
(Gen. Reg.. o. P
(Amended February 20, 1952)
B m b ,x'8able------ --------------------------------------------------- PAID BY,,
nost
S
_
U.
. -
(Department, bureau, or establishment)
: 3
-----------------------------------------
Voucher prepared at = SA 39 3
---------------- -------------------- (Give - - ----- place and date) --------
THE UNITED STATES, Dr., Payee's Account No. _5z. ________
----------------------
-----------
(Payee)
---------------------------------------------------- .- (State)
----------------------
(Address) ( itY
ARTICLES OR SERVICES UNIT PRICE
No. and Date of Date of Delivery (Enter description item number of contract or Federal supply QUANTITY
Order or Service schedule, and other information deemed necessary) Cost Per
Discount Terms
PAYMENT:
Complete ^
Partial ^
al ^
Fi
n
I
to Weight Government B/L No. Total
Shipped from. (Payee must NOT use this space)
I certify that the above bill is correct and just and that payment has not been received.
(Sign original only)
25X1A
25X1A
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
6-,92 -------- r ---
SIGN
ORIGINAL
ONLY
(Signature or initials
Date ------------------------------------------
------------------- ------------------- ----------
Title APPr?y_n;-Officer--------------------
TEN AGREEMENT IN ANT FORM
RIT
25X1A
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be shown; other classification optional)
on Treasurer of the United States in
Check No. -_PZ~--dated ------------, 19_- ? for $___-b_ j-----yG ------- ---------- { favor of payee named above.
-----------
Paid by
Payee is cn od?1~a ooin
Cash. $------------------------?
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT W
? When a voucher f~ig~ d in e name of a corn va~n' ~o~ryc~or oration, the name of the person Pei -----------------------------------------------------------------
writing the company , per John asw f fL of",Xslth car? C1ra=11b64-006 R000400030010-4
"John Doe Company, per ohn Smith, Secrets , or r I __________
on the line below "Approved for $ _____- gnature only Is ncc- Title _____________________________
}If the ability to certify and authority to approve are combined in one person, one s
and ie .22900-5
essary, otherwise the approving officer will sign _______----_-
his official title.
 p
, '~'
(Gen. Reg. No. 11, Supp. No. 11) ervices Other Than Persona
Form pros bed b ' ?
Comptroller o tized - Ap _o~ cl ~' MWWDW4- 0 OR000400030010-4
tember
Se
U. S_ ---------------- Cost Reimbursable -------------------------------- Sheet No. _____ t---- of Bureau Voucher No. -----9 --
(Department, bureau, or establishment)
No. and Date
Date of
ARTICLES OR SERVICES
QU
AN-
UNIT PRICE
AMOUNT
Of Order
Delivery
(Enter description, item number of contract or Federal supply schedule,
TY
ITY
or Service
and other information deemed necessary)
Cost
Per
Dollars
Cts.
PAYROLL SYSTEM IV
Direct Labor Costs properly chargeable t
Contract A101 for the period 10/10/55
thru 10/16/55
Week Ending 10/16/55
790.
97
2
X1A
1,226.
oo,
Total Labor and Overhead
2,o16.
97
Sanitized - Approved G v G OF IAA.- P64-U
U360R
00040
00300
1 0-4