PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400090035-1
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 3
• Document Creation Date: December 12, 2016
• Document Release Date: March 8, 2002
• Sequence Number: 35
• Publication Date: June 5, 1956
• Content Type: FORM

8tTi3tdnrd Form No. 1034-Revised
Form prescribed by
Com troller General, U. 8ApprOV2
vf IS* * faS
September 7, 1950
(Gen. Reg. No. 51, 9upp. No. 11) SERVIC
(Amended February 20, 1952)
Date of Delivery
or Service
U. S. --------------- COST BEIMBLWABLE ----------------------------------------
(Department, bureau, or establishment)
Voucher prepared at ----- _________________________________ ( ----------------------------------------
Give place and date)
THE UNITED STATES, Dr., Payee's Account No. _- 938-__--
- --------------------------
- -----------------------------------
(Payee)
-----------------------------------------------------
-------------------------------------------
state)
(Address) (City) (
No. and Date of
Order
PAYMENT:
Complete ^
Partial ^
Final ^
UNIT PRICE I AMOUNT
Total
I Shipped from to Weight Government B/L No.
(Payee must NOT use this space)
I certify that the above bill is correct and just and that payment has not been received.
/ STAT1N,TL/jp
Date
Contract No. A 101
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
schedule, and other Information deemed necessary)
Discount Terms
Date
Pursuant to autl}e)rity vested in me, I certify that this account is correct and proper for paymen
SIGN
ORIGINAL
ONLY
Title cONMOTING OFFICER. ------- STATINTL
---------------------- -----
Differences ---------------------------------
-----------------------------------------------
------------
f
o y ------1 - -~---
Amount venhea; correct
(Signature or initials) ,. _ r --------------------------
0R000400090035-
Bu. Vou. No- ------
9,780
62
T-2.,780
---------------
---------------
---------------
STATINTL
Date -------------------------------------------------------------------------
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be shown; other classification optional)
APPROVING OFFICER
STATINTL
f on Treasurer of the United States in
Check No. ------------------------ dated ---------------------------- 19-=-- for $-------------------------------------- 1 favor of payee named above.
----------------------------
Paid by Yee -------------------------------- ------only
Cash. $ on 19 Pa (51ss or(dn+l only)
+ When a voucher is signed ora recelpted in t e aame of a company or corporation, the name of the person Per ---------------------------------------------------------------
writing the company oreorpo ecre Yt Yte 1 e' -00360R000400090035-1
"John Doe Company, per John ith, 9ecre ary' or
essary; he ability to certify and authority to approve are combined in one person, 'one signature only is nee- Title _______________________________________________________
t If i
esarotherwise the approving officer will sign on the line below "Approved for $______.____________", and 1e-22900-5
over his official title.
 Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090035-1
Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090035-1
 U DIVISIONAL DETAIL ACCOUNTS PAID JOURNAL
COST CENTER DATE CHECK
NUMBER
6-6
00
00
00
MO
0
08
DAY
01
01
YR
6
6
-AC For Release
-- - proved
O-U N0~021S061p p IDR R E P O R T S 0090035-1
F1
PURCHASE ORDER
PAYEE'S (ABBREV.) NAME OR INVOICE
NUMBER
RECEIVING
REPORT
NUMBER
22489
22542
C.E.
CODE
M.J.O.
o24
!5024
Approved ForReleate.2002/06/10 : CIA-RDP64-0l@60R000400090035-1
DATE PAGE
REPORT NO.
DISTRIBUTION
AMOUNT
114;$0
22 318'
336""7
33677
33877
29223