PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400090022-5
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 12, 2016
• Document Release Date: March 8, 2002
• Sequence Number: 22
• Publication Date: June 5, 1956
• Content Type: FORM

.
Stanlfard Form No. 1034-Revised T
Form prescribed b rr(r~ vp ffiOomptrollor General,. eApproved Fgl'~fra51t1- NliJP~AG
PO 80004
Bu.
F ptember 195 SERVIC It
} (Gen. Rig. No. 51, t#upp. No. 11)
(Amended February 20, 1952)
U. S- _ COST__ IMBURSABLE--------------------- ----------------------------------------
(Department, bureau, or establishment)
Voucher prepared at ----------------------------------
--------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No. ____ 1 013 ___
----------------------------------------------------------
- (Payee)
---------------
-----------------------------?---------------------?-- (City) (State)
(A (dess) ARTICLES OR SERVIC[iS
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)
Discount Terms
Costs
PAYMENT:
Complete F1
Partial F1
Final 11
i
to Weight Government B/L No. I Total
Shipped from I (Payee must NOT use this space)
I certify that the above bill is correct and just and that payment has not been received.
STATI NTL A ) (Sign original only)
Date ____5!
Per ------
Differences ---------------------------------
295
55
W5
55
--------------
---------------
---------------
Amount verified; correct f ----
Req. No. Date
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
/f a
CONTRACTING OFFICER
SIGN
ORIGINAL
ONLY
(Ant tf lzea uerruylng viu ee
~TATI NTL
Title ---------------------- ----------------------------------------------
STATINTL Date --------------------------------------------------------------------------
- ---------------------
FORM
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY
b
rO
STATINTL
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be shown, other classification optional)
APPROVING OFFICER
-------------- f on Treasurer of the United States in
Check No. ------------------------ dated -------------- ---------------- 19__---, for $------------------------ favor of payee named above.
Paid by --- -----------------------------
- 19----- Payee - ,:j; o,frfn.: only)
Cash, $------------------------? on -----------------------------
Per -----------------------------------------------------------------
When a voucher is signed r cei tad in t~ ame o!a company or corporation,q~the name of the person
writing the company or corpor QAE~ i;4 oi''"1rr ur er~i~3' R 0036 OR000400090022-5
"John Doe Company, certify and authority to approve are combined I a one person,'one signature only is nec-
essary, otherwise the approving officer will sign on the line below 'Approved for $...... .__-___--____", and 18-22900-5
over ms official title.
O. Vou. No- -------------------------------
D
0090022-5u60
0
Vou. No- ---------------------------------
-- 1__ - ----------------
 STATINTL
L Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090022-5
Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090022-5