PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400090078-4
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 12, 2016
• Document Release Date: March 8, 2002
• Sequence Number: 78
• Content Type: FORM

~aadur-~ Form xo. loa4--g,~
Form prescribed by~ J-1~
Oompptroller C3eneral, U. 9.
8eptomber 7 19b0
(Qan. Reg. No, bl, Cupp. No. 11)
(Amended February 20, 19b2)
oved FO~L~~~~R~'~R ~~~~~SOR~&+~R00~4$~~7~-~----?--------------------
-~' SERVICES OTHER THAN PERSONAL'y'~ Bv. ~a~. No. _________ ~2_________________
U. S. ---------Cost-Reimbursable--------------------------------~--------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at ----------------------------=---------------------------------------------------------------------------
(41ve place and date)
THE UNITED STATES, Dr., Payee's Account No. ___~~~______.
To -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
No. and Date of
Date of Delivery
ARTICLES OR SERVICES
(Enter description item number of contract or Fedezal supply
UANTITY
UNIT PR1CE I
AMOUNT
Ordee
or Service
schedule, anc~ other information deained neeeseary)
Q
Colt
Per
'nollara
Cta.
Discount Terms
Costs -
574
~4E
PAYMIENT:
Complete ^
Partial ^
Final ^
Use continuation sheet{a} if necessary
Shipped from to Weight Government B/L No.
Total
_ ~, 743
(Payee musk NOT use this space)
I certify that the above bill is correct and just and that payment has not been received.
_
Differences ---?----------------------------
-?------------
-----
STATI NTL (glen original only)
Date __ ~ _ ~ --
~ ~ ~
Amount verified; correct r ___________
'~`
Per
{Signature ar initials ____ ________
________________
_____
Pursuant to authority vested in me, 1 certify that this account is correct and proper for payment.
SIGN
ORIGINAL
ONLI(
Title --------------------------?--------------------?-------- Date ----------------------?-----------------------------------------?---?--
THE REVERSE OF 7N1S FORM MUST BE E%ECUTED WHEN PURCHASES ARE MADE OR SERYlCES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
STATINTL
Check No. ________________________dated _____________.____________.__, 19____., for $_____..__________._____.______________ on Treasurer of the United States in
Paid by j {favor of payee named above.
! Cash; $------------------------? on --?--------------------------------~ 19_?--. Payee .-------?-----------------------------------------------------
----------
iat[n osidn~l ody>
? When a voucher is signed or receipted in the name of a company or corporation, tho name of the person per _ _- -
writing the company or corporato namo, as well as the capacity m which he signs, must appear. For exampio: ?'-'?--?-??-'-----"-?'"-'----'-_?-""""'-
"John Doo Company, per John 9 ith, Secretary" or "Treasurer' , as the case may be,
tIf the ability to certifyana ant~w~ap~o~, ~e~Q~~~~6~~k@tu~'.994~[~l'~,~ 4-003'6BRODDA,ODD9.OA7$.=4-------------------------
essa otherwise the approving otIl wi s gn on he ine a ow p of e ____ ___ _____
-~;~~'+a nfnnlal title. ~e-zzeoo-s
STATINTL
STA
Title _ TINTL
~
~
O~cer)
 ~ATINTL
Approved For Release 2002/06/10 :CIA-RDP64-003608000400090078-4
Approved For Release 2002/06/10 :CIA-RDP64-003608000400090078-4