PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

Document Type: 
Collection: 
Document Number (FOIA) /ESDN (CREST): 
CIA-RDP64-00360R000400090070-2
Release Decision: 
RIPPUB
Original Classification: 
K
Document Page Count: 
2
Document Creation Date: 
December 12, 2016
Document Release Date: 
March 8, 2002
Sequence Number: 
70
Case Number: 
Publication Date: 
April 23, 1956
Content Type: 
FORM
File: 
AttachmentSize
PDF icon CIA-RDP64-00360R000400090070-2.pdf75.75 KB
Body: 
Standard Form No. 1084--R UBLre Y U ULIl form prescribed by roved Fo OR f-1 . F V A\~ ---------------------- tro", General, U. S. Com ~ No. 11 SERVICES OTHER THAN PERS 0360R0 $0 7 0=2 (9an. epee b 8u 1950 ( g pp ) ONAL Bu. you. No. -25 ---------------------- (Amended February 2O, 1952) U. S. Oost--Aeimbursable-------------------------------------- ------------------------------------------------ (Department, bureau, or establishment) Voucher prepared at ------------------------------------------------------------------------------------------------------- (Give place and date) THE UNITED STATES, Dr., Payee's Account No. _ QZ(2 -_------ ---------------------------------------------------- (Payee) SAPC. 35yC COPY, / OE and Date of No Date of Delivery ARTICLES OR SERVICES (Enter description item number of contract or Federal supply UANTITY UNIT PRICE AMOUNT . O i S and other information deemed necessary) schedule Q rder or erv ce , Cost Per Dollars eta. Discount Terms Cost 53,916 .22 PAYMENT: Complete El Partial ^ Final ^ Use continuation sheet(s) if necessary Shipped from to Weight Government B/L No. Total 51 ~-?a (Payee must NOT use this space) I certify that the above bill is correct and just and that payment has not been received. Differences --------------------------------- --------------- ----- (Sign original only) _ ?_* -- Date --------------------------------- --------- , j Amount verified; correc t r - Per (Signature or initials -- - - ------- ---------------- ------ 11 Contract No. ""-- Date Req. No. ATI NWT Pursuant to authority vested in me, I certify that this account is correct and proper for payment. SIGN ORIGINAL ONLY CONT CTING OFFICER e% -r' A T,,, ,T, Title -------------------------------------------------------- t ------- ' ----------------- rz a yn THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM TATINTI ACCOUNTING CLASSIFICATION (Appropriation Symbol must be shown; other classification optional) APPROVING` OFFICER Check No. ------------------------ dated ___-------__------_-____---- 19-----, for $------------------------------------- -~ on Treasurer of the United States in favor of payee named ahnve- Cash, $-----------------------, on ------------------------------------Payee; -- ---------------- ---- --------------------------------- (Sian orl?Ind only) When a vouebe5 is signed or receipted in the name of a company or corporation, I be name of the person writing the company or corporate name, as well as theca parity in which he signs, must appear. For example: "John Doe Company, per John Sp~l J ~r hry t1 f 1f the ability to certify and anl'FLhltlltbbyjsrbFe~a`e~to~Fl~c4+ i~nAtxr~ essary; otherwise. the approving officer will sign on the line below "Approved for $--__-_-_-_-_-_----_ ', and Per ----------------------------------------------------------------- 4-OOgAQROOO400090070-2 - STATINTL L Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090070-2 Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090070-2