PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400090111-6
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 12, 2016
• Document Release Date: March 8, 2002
• Sequence Number: 111
• Publication Date: April 23, 1956
• Content Type: FORM

Form prescrieea n
Oompptroller General,1J. s. Approved
September 7 1950
?
(Gen. Reg. No. 51, Supp. No. 11)
(Amended February 20, 1952)
ARTICLES OR SERVICES
(Enter description Item number of contract or Federal supply
schedule, and other information deemed necessary)
Discount Terms
U. S. _ COST REIMBURSABLE
--- -------------- ----- --------------------------------- --------------------------------
(Department, bureau, or establishment)
Voucher prepared at ------------------------------------------------ ------- -------------------------------------------
l
t
i
THE UNITED STATES, Dr.,
ace an a
e)
(G
vo p
Payee's Account No. _93l_____-_-
To ------------------=---------------------------------------------------=------------------------------------------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
(Address (City) (State)
No. and Date of
Order
Date of Delivery
or Service
PAYMENT:
Complete ^
Partial ^
Final ^
t -----------
Shipped from to Weight Government B/L No. Total
I (Payee must NOT use this space)
I certify that the above bill is correct and just and that payment has not been received.
.STATINTL
61-O860RQ00400090111241
i s Bu. You. No- ---------------------------------
Differences ---------------------------------
-----------------------------------------------
Amount verified; correckfor r________
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
ORIGINAL
r!5 SIGN
uB ONLY
CONTRACTING OFFICER
7, 598
78
_7.598
---------------
---------------
---------------
--~3=sX
Offi ------ ~ A
gTATINITI
Title -------------------------------------------I/-\ I II N I L Date --------------------------------------------------------------------------
-------- ?---
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANT FORM
STATINTI
APPROVING OFFICER
Check No- ____-----_- -------- dated ---------------------------- 19 ------ for $-------------------------------------- , on Treasurer of the United States in
Paid by favor of payee named above.
Cash, $ on 19 Payee ? ? - ------? -
------- ------------ ------
_______________ iSlrn. uld.ul ody)
' When a voucher is signed or receipted in the name of a company or corporation, the name of the person Per
" Joking the company or corporate na~p~,~g t olr Which ee s e a
John Doee Company, per John SmROit{Iie6NtV~yoFCAfr 0 s~ ~ , 64-0(60R000400090111-6
fIf the ability to certify and authority to approve are combined in one person, one signature on y s nea- Title -------------------------------------------------------
essary, otherwise the approving officer will sign on the line below "Approved for $______-____________ ,and
ever his official title.
Use continuation sheet(s) if necessary I I
 STATINTL
L Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090111-6
Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090111-6