PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400090030-6
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 12, 2016
• Document Release Date: March 8, 2002
• Sequence Number: 30
• Publication Date: June 5, 1956
• Content Type: FORM

5i4nrd Form No. 1034-Revised
Form prescribed by t~~LA~~.G-7
Oomptroller General, U. sApproveG~F
September. 7 1950 PP rA~
(Gen. Ree. No. 51. Auon. No. 11)
SIGN
ORIGINAL
ONLY
STATINTL
-------------------------------------------------------------------
U. S. -------------------------- C_4T-_IIIT
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No. ------- 1034
TO -----------------------------------------------------------------------------------------------------------------------------------
(Payee) ,
No. and Date of
Order
Date of Delivery
or Service
PAYMENT:
Complete ^
Partial ^
Final ^
(Enter description Item number of contract or Federal supply
schedule, and other information deemed necessary)
Discount Terms
Costs
Shipped from to Weight Government B/L No. Total
(Payee must NOT use this space)
I certify that the above bill is correct and just and that payment has not been received.
STATI NTH ,) (Sign original only)
Date ___5)
that this account is correct and proper for payment
By ----
CbNTRACTING OFFICER
Title ----------------------------------------------------------
CHASK, 4D
8000400090030-6271
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
STATINTL
APPROVING OFFICER
I Check No- --------------------- -- dated -----------------------------, 19----_, for $----------------__---------------------i on Treasurer of the niteStates in
Paid by favor of payee named above.
Cash, $----------------------- On ------------------------------------- 19-----. Payee -----------------------------t-S-lra---eoriginoriginal -----Duly) -----------------------------
cher is signed or eceipted in the name of a company or corporation, the name of the person
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hn tiitli, 0ecrLrtOy"'
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John Doe Company, per
prove are combined in one person, 'One signature only Is nec-
to a
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tIf the ability to certify an
roving officer will sign on the line below "Approved for $------------------------ nd
the a
i
h
Per -------------------- _______ ____________________________
-003608000400090030-6
Title _______________________________________________________
pp
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erw
ie-oases-s
essary; ot
oer his official title.
84
84
-- ------------
---------------
---------------
89
Amount verified; correct for
(Signature or initials) _____c,__ ________________
 Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090030-6
Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090030-6