PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400090006-3
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 3
• Document Creation Date: December 12, 2016
• Document Release Date: March 8, 2002
• Sequence Number: 6
• Publication Date: June 20, 1956
• Content Type: FORM

Standu;rd Form NO. 1034-?Revisod D. 0. Vou. No.------- 2~_i__________________
Form prescribed b PUBLIC VOUCHER FOR PURCHASES? "T)
Comptroller General, U. S.
Beptember7, 1960 Sgpprove,?F0S~/`tAf4+~AV360R0~00~90006-3
(Gen. Reg. No. 51, upp. No. 11 u. ou. o. ---------------------------------
(Amended February 20, 1952)
U. U.S. Q$T _ RFII~IBURSABLE--------------------.._..--------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr.,
Payee's Account No. 1081_----
To -------------------------------=---------------------------------------------------------------------------------------------------
(Payee)
f
D
N
f Deliver
te
D
ARTICLES OR SERVICES
(Enter description Item number of contract or Federal supply
TY
AN
UNIT
PRICE
AMOUNT
ate o
o. and
y
o
a
i
S
schedule, and other Information deemed necessary)
QU
TI
Order
erv
ce
or
Cost
Per
Dollars
Cts.
Discount Terms
12, 787
- 39
Costs
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
_
Shipped from
to Weight Government B/L No.
Total
l'.~. 78
X3
(Payee must NOT use this space)
I certify that the above bill is correc
t and just and that payment has not been received.
STATINTL
Differences ---------------------------------
---------------
-----
(Sign original only)
STATINTL
-----------------------------------------------
---------------
-----
Date ----
55 NO ----
-------------------------------------------- --
-
-
Amount verified; correct for
---------------
-----
--------
-
Pei
_._
(Signature or initials -------------------
----------------
------
Contract N
o. A101
Date Req. No. Date Invoice Rec'd.
Pursu
count is correct and proper for payment
App
t----- -/--= ----
or za er g fficer)
SIGN
STATI N
L
By
ORIGINAL
`-
Title -----
------------------------------------------------
o
Title ------- Date --------------------------------------------------------------------------
ST-ATNi - Tt-----"-------------- - -----
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
STATINTL
a
APPROVING OFFICER
Trw
Check No- ________________________ dated ------------------------------ 19 ...... for $-------------------------------------- on Treasurer of the United States in
Paid by j . favor of payee named above.
.................., 19 ------ Payee ._______...-__.._____._._---' (Big. oddnd only)
-- --------------------------------------
9
? When a voucher is signed or receipted in the name of a company or corporation, the name of the person I Per -----------------------------------------------------------------
writing the company or corporate nayy~,,ggpp~
` ~t"~' Fe%F1 64-003608000400090006-3
'Thu. Doe Company, y>er John Sn1A 'b rAV*r.F ' `e ""S
nec- Title _______________________________________
tIf the ability to certify and authority to approve are combined in one person,'one signature only Is , and
essay otherwise the approving officer "111 9 sign on the line below "Approved for $________---------
t
over his official title. 1e-22900-5
 25X1A
L Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090006-3
Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090006-3
 .. DIVISIONAL_D_ETAIL ACCOUNTS PAID JOURNAL.___..
COST CENTER DATE CHECK
I I I I I NUMBER
MO
05
lease
200.2106 Arov_eA C For ren iI N T S/ cibRf&,o?arooo90006-3
RI-
DIVISIONAL SUMMARY ACCOUNTS PAID JOURNAL_
PAYEE'S (ABBREV.) NAME
HEWLETT /PACK A RD
^ CONSOLIDATED ACCOUNTS PAID DISTRIBUTION
.. I I
PURCHASE ORDER
OR INVOICE
NUMBER
RECEIVING
REPORT
NUMBER
C.E.
CODE
DISTRIBUTION
AMOUNT
ACCOUNT
12700
Approved For Release 2002106110 CIA-RDP64-00360R000400090006-3
11, ~