PUBLIC VOUCHER FOR PURCHASES AND SEVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400060021-9
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 11, 2016
• Document Release Date: April 22, 1999
• Sequence Number: 21
• Publication Date: December 20, 1955
• Content Type: FORM

Standard worm No. 103 R
ora tr A
bed Ill ni ized - LgWgOft EitJRO#10 84-00'~6~0YZ'Db`~400II60II2'1-=9-----
- Om trollerreGscribed Ill $.
0
(Gen. fl g. No h 1, 4 pp. No. 11) SERVICES OTHER THAN PERSONAk,..' Bu. Vou. No _-___________
(Amended February 20, 1962)
U. S. Cost Reimbursable
---------------------- --------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at ----------------. ------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No. ------- 6_o??
To -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
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 docrned necessary)
Q
Cost
Per
Dollars
Cts.
Discount Terms
Cost
2,525
01
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
_
Shipped from to Weight Government B/L No.
Total _
2 2 .
01
(Payee must NOT use this space)
I certify that the above bill is correct and just and that payment has not been received.
Differences ---------------------------------
---------------
-----
(Sign original only)
STATINTL
-----------------------------------------------
---------------
-- P.Vpo
Date -- rr --------------
Amount verified; correct for ___ _______
Contract No. ?.A1Qi Date Req. No. -1 -1 Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
f APproved1 $ ------ 2.-Ci2-5-01-------------
ORIGINAL
ONLY
Title . Contvacting--4ftLc r------------------ STATINTL
ST
/A,
ng 0 cer)
ed_.Certif3:ing_ _Qgficer----_-------
APPROVED:
STATINTL
proving Officer
Check No. ------------------------ dated ------------------------------ 19---- -, for $---------------------------- ---------- on Treasurer of the United States in
Paid by ~ favor of payee named above.
{ Cash, ------------------------ I on ------------------------------------, 19-----. Payee ------------------------------- -------- ----------------
i5l , o,L Ir I only)
When a voucher is signed or roceipted 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 appear. For example:
"John Doe Company, per Jo Smith Seereeta_ry", A Treasurer", as h ace u b
't It the ability to certify an ~t i fl~~7ove C~t1111t1~1A~t a 1501 gNS~ ~~~~119 iq
.-_essa ? otherwise the approving o~~~SSS er wf[f a on tt~~~tie~~-'nt3'tfoRfw~' ruce2f for 3_~______
,I., ?m "4.1 titla.
(Signature or initials) ___ ----------------------------
Date Invoice Rec'd.
Per -----------------------------------------------------------------
RDR64-00 6.QR0.Q0400D.6II021-.9-_____
ATINTL
 Standard Form No. 10815-Revised
Form prescribed b *~ ?
Comptroller General dnitized ' JSv cPP& ~ ruL9 i *~0360R000400060021-9
September 7, 19
(Cen. Reg. No. 51, Supp. No. 11) Services Other Than Personal
CONTINUATION SHEET
U. S. ------------ ost_ Reimbursable ----------------------------------- Sheet No. ---1------ of Bureau Voucher No. ---
(Department, bureau, or establishment)
No. and Date
Date of
ARTICLES OR SERVICES
QUAN-
UNIT PRICE
AMOUNT
of Order
Delivery
or Service
(Enter description, item number of contract or Federal supply schedule,
and other information deemed necessary)
T1TY
Cost
Per
Dollars
Cts.
SYSTEM-IV
PAYROLL
Direct Labor Costs properly chargeable to
Contract A101
for the period 11-13-55 thru 11-20-55
STATIN
L
Week Ending 11/20-55 STATIN
L
Overhead computed at interim rate
STA
I NTL
of
Total Labor, Overhead and Other Costs
F2 .525-
'al
Sanitized - Approved.FoioRe1ease : ?4A-RDP64-00360R000400060021-9