PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400090073-9
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 12, 2016
• Document Release Date: March 8, 2002
• Sequence Number: 73
• Publication Date: April 23, 1956
• Content Type: FORM

LtBatdurc~. Form. No. 1034-"Itevlse3
r. - ,iform pprescribed b [n1
-- Ool~trollcr General, v. s. Approved I~~e~~0~/'I~ ~
eptembcr 7 1960
eaen. Reg. No. 51, ~npp. No. In ~` SERVICES OTHER THA P
(Amended February 20, 19b2)
D. O. Vou. No. ----------?--------------------
~ttnn
~~ 00~60R000400090073-9
1\~ ESu. You. No. _ --.------ -----------?----?
v. s. __ c~~t_ ~~~.~ab~------------- -------------------------------------------------
--------------------
(Department, bureau, or establishment)
Voucher prepared ai --...--------------------------------------------------------------------------------------
-------------- (Give Place snd dnte)
THE UNITED STATES, Dr., Payee's Account No. ___~?-~_______
To _ --------- ----------------------------------------------------------
--------------------------------------------------------------
(payee>
-----------------------------------------------
------------------------------------~Addross~--------------------------- (City)-------- (
6tate)
ARTICLES OR SERVICES
No. and Date of Date of Delivery (Enter description Item number of contract or Federal supply QUANTITY
Order or Servico schedule, an~ other Information doomed noceaaary)
Discount Terrna
UNIT PRICE
AMOUNT
Cost
Per
Dnllara
Cts.
~~~
~~, ~a~.
a7.
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
ht Government B/L No.
Wei
Total
,.,
iCS~+
i
g
Shipped from to
I certify, that the above bill is correct and' just and that payment has not been received.
__ __ _?_
(Payee .must NOT use this space)
.Differences --------?- --- ------------- -
-------- ------
----
(Sign original only) - - -
ST TI T
~ ___________________ ___ ~ _
---
______-________
_____
Date ----- -
---------------------------?----------------"--
correct for
d
if
t
A
-
------------ ,g
`~ Z~3
-:-
Pe
___________
;
ver
ie
moun
(Signature nr initials) _ -- -----
-- -----------
------
r__...,.F nl,. A9117 Date Req. No. Date Invoice Rec d. '
Pursuant to authority vested in me, 1 certify that this account is correct and proper for payment.
~A
SIGN
'y ~ ORIGINAL
ONLY
t ------------
Title -------------------------~?fP~I~I~ITL-----------------------=----
V I /'9 I I I V I L
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED R'ITHOUT YYRITTEN AGREEMENT IN ANY FORM
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be shown, other clnsaification optional)
STATINTL
1PPROVING OFFICER ,
_____ Jon Treasurer of the United States in
(Check No. ___---------------------dated -----_----------- ---- ------. 19----- for $---- --- ---- ---- l Favor of payee named above.
Paid by j 19 Payee - -------------- - -------------
. C?n ----------- -----' -----? - i61rn orirlvsl oo~r)
Cash. $------------------------ -------------------
? When s voucher is signed or r .celptcd in the name of a company or corporation, the uamc of the person Per _________________________________________________________________
writing l,hc company or corporat~~~ t~,~c7'~~'i~~~~~t~'.0"~`~CIi~eI~'~r~4-003608000400090073-9
"John Doe Company, )~cr John t , 8ecre ary' , o r
tIf the ability to certify and authority to approve arc combined in one hm?snn,'one signature only is nee- Title ___________________________________________ __________
essary; otherwise the approving n[Iloer will sign on the line below "Approved for $___________________", and
le--22P0n-v
over his otl'icia] title. -
 TINTL
Approved For Release 2002/06/10 :CIA-RDP64-003608000400090073-9
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Approved For Release 2002/06/10 :CIA-RDP64-003608000400090073-9