PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400090103-5
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 12, 2016
• Document Release Date: March 8, 2002
• Sequence Number: 103
• Publication Date: April 23, 1956
• Content Type: FORM

D. O. Vou. No. --------------------"----------
ptAtndqrd Form No. 1084-Revised p~ 1i~
Form prescribed
Oom t ,y qpprovecPWTCeMQW 2TA10 "C W-k'400;
4-0 360R000400090103pepelmbr 719b 66 1 Bu. Vou. No - ------------ ~----------'------
Oen. Reg. No. 7uary p. 20, o. 11) SERVICES OTHER THAN
,Ofe__R?burs~ble. -------------- PAID BY
U. S. _ -------------------
------------------------------------ -
or establishment)
bureau
ent
t
-
,
,
m
(Depar
-----.date-----) -----------------------------------------
-----------------------------------------(Give
Voucher prepared at
THE THE UNITED STATES, Dr., Payee's Account No. _______905___
---------------------------------------------------------------------------
O (Payee)
-- ------------
---------------- Citvl -----------?------------- (State) -----
(
No. and Date of I Date of Delivery (Enter description item number of contract or Federal supply
Order or Service schedule, and other Information doomed necessary)
Discount Terms
PAYMENT:
Complete ^
Partial ^
Final ^ Use continuation sheet(s) if necessary Total
Shipped from to Weight Government B/L No.
(ayee must NOT use this space)
I certify that the above bill is correct and just and that payment has not been received. Differences ---------------------------------
STATINTL ? /~
5J4-,76o
57 6o
43 /'
----------------------------------------- -- -
Amount verified; correct for -----------
is) ~~66 3
(Signature or initia__ ` ------
Contract No. A 101
Req. No Date Invoice Recd.
Pursuant to tF4thority vested in me, I certify that this account is correct and proper for payment.
SIGN
ORIGINAL
ONLY
Title --------------------- -- ------STATINTL------------------
_
Date --------------?----------------------------------------------------------
Title ---------------------------------------------STA1INTL
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANT FORM
ST~ TL ACCOUNTING CLASSIFICATION (Appropriation Symbol must be shown; other classification optional)
APPROVING OFFICER
f on Treasurer of the United States in
----_, 19----_, for $------------------------------ 1 favor of payee named above.
I Check No. -dated
-----
----
Paid by = - -
Cash, $-------------------------- on ___-____ 19 ------ Payee --- iefrn .1.1n.4 odY1
Per --------------??----------------------------------------------
? When a voucher is signed or receipted in the name of a company or corporation, the n ems For eample:
writing the company or corporate e9RIF~~+p~(~t t nwhJ?llkL~?A7I}, , f`IA-C2~~ 4-00 00040009010-_
'John Doe Company, per John "p, decre t11 & lU 1'6'Sl CIS
t If the ability to cart fy and authority to appprove are combined in one person, one s gn- u n y ?and
t 16-22400-5
eseary, otherwise the approving officer will sign on the line below "Approved for $_.____.____
over his official title.
(Authgt d er y n Olcer)
 STATINTL
L Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090103-5
Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090103-5