PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• 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
• Publication Date: April 23, 1956
• Content Type: FORM

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