PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400090067-6
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 12, 2016
• Document Release Date: March 8, 2002
• Sequence Number: 67
• Publication Date: May 9, 1956
• Content Type: FORM

Standard Form No. 1034-Revisgd
Jormi; prescribed TT Q PUBLIC VOUCHER FOR PURCHASES 'AND
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September 7 1950 A roved or 1 00360R0 0 0 00
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(Gen. Reg. No 51 dupe. No. 11) e rr
(Amended February 20, 1952)
U. S, -- O9 T--REItIMUR ABLE---------------------------------------------- ------------------------------------
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Give place and date) I sA?C ~'
THE UNITED STATES, Dr., Payee's Account No. _956 ---------
TO -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
No. and Date of
Order
Date of Delivery
or Service
ARTICLES OR SERVICES
(Enter description Item number of contract or Federal supply
schedule, and other information deemed necessary)
Discount Terms
PAYMENT:
Complete ^
Partial ^
Final ^
OPY OF
Shipped from to Weight Government B/I, No. I Total
(Payee must NOT use this space)
STATINTL
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
SIGN
GINAL
[/J.Z ORI
CONT CTING 0 FICER STATINTL
--------------- -- ----------------------------
-----------------------------------------------
-----------------------------------------------
(Signature or initials)
Date
t ------------------
$1,658
---------------
---------------
--------------
, # ?5'
Title ---------------------------- ---------------------------------------
Title ---------------------------------------------------------- Date --------------------------------------------------------------------------
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANT FORM
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be shown; other classification optional)
STATINTL
n Treasurer Check No- ------------------------ dated ------------------------------ 19 ------ for $-______-------_-------_--________-----{ oreasurer of the United States in
Paid by j favor of payee named above.
I Cash, $------------------------- on ------------------------------------? 19-----. Payee -------------------------------------------------------------------------
'Bit' o,lifn.l s iy)
' When a voucher is signed or repc~e,~ipte~d in theq namec of a company or caor~py~opr~a~) ipon~, j.th~e name of qthe qp~erson~:
writing the company or corporate fn' lf~f ~tFi 9"h~ Nr - tip ib46A-~f I Al r, I. x l l&
John Doe Company, ))er John S e o P t c
t If the ability to certify and authority to approve are combined in one person, one signature only is nec-
essaTi otherwise the approving officer will sign on the line below "Approved for $------------------- , and
oves official title.
Per -----------------------------------------------------------------
i4-00360 R000400090067-6
Title -------------------------------------------------------
 STATINTL
L Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090067-6
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Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090067-6