PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400090100-8
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 12, 2016
• Document Release Date: March 8, 2002
• Sequence Number: 100
• Publication Date: April 23, 1956
• Content Type: FORM

D. O. Vou. No. -------------------------------
4r4 Form. No. 1034-Re Ti;e3 1"0' T~' CH~ 1110 T--~
orin
pt oller General,' . S. Appromed'I"01'
8eptcmber 7 1950 '1CeY @ ZTlU2~ - -00360R00040009010(3~?2
(Den. Reg. No. 51, 9upp, No. 11) SERVICES OTHERBu. You. No. - -__-_--------------------------
(Amended February 20, 1952)
U. S. _ Cost Reimbursable -----------------------------------
(Department, bureau, or establishment)
------ --------- -----
Voucher prepared at -------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No. ------- 903--_
To -------------------------------------- ------------------------------------- ------
(Payee) -
(Address) k" M
sy)
I ARTICLES OR SERVICES
No. and Date of
Order
Date of Delivery
or Service
(Enter description item number of contract or Federal supply
schedule, and other information deemed necessary)
Discount Terms
PAYMENT:
Complete ^
Partial ^
Final ^
Shipped from
Government B/L No. Total
I certify that the above bill is correct and just and that payment has not been received.
STATJ NTL4 /I-
Contract No. A101 Date eq. D.
Pursuant toythority vested in me, I certify that this account is correct and proper for payment.
SIGN
ORIGINAL
:--ID ONLY
t ------
15,826
15,826
---------------
---------------
---------------
Lo /
0 ?tATINTL .
J
Title ------------------------------------------------------ -- -I h I II V I L. Date --------------------------------------------------------------------------
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be shown; other classification optional)
STATINTL
`ICER.
--------------- 19 ------ for $-------------------------------------- on Treasurer of the United States in
Check No_ ________________________ dated ____________ _ { favor of payee named above.
Cash, $-----------------r_- - ------------------ 19 -----?
f~,-'---- ?,.....,r....r~..
* When a voucher is signed or receipted in the name of a company or corporation, the name of the person
writing the company or corporate name, as well as the capacity in which he signs, must appear. For example:
'John Doe Company, per John Smith, Secretary", or "Treasurer", as the case may be.
+rf the ahility to certify aad authority to approve are.combined in one p arson _on a signature only is nee-
(Payee must NOT use this space)
Differences ---------------------------------
Amount verified; correct
(Signature or initials)
P64-00360R000WD6666100-8
Per -----------------------------------------------------------------
Title -------------------------------------------------------
 ~ATINTL
Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090100-8
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