PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400100050-2
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 17, 2016
• Document Release Date: December 16, 1999
• Sequence Number: 50
• Publication Date: July 12, 1956
• Content Type: FORM

Standard Form. No. 1084-Revised
F, r'rlproscribed by rT~pp
Comn.rller Gewral- U, -
(Gen. Reg. No. 51, 8ifp f.No. 11) A6
-mended February 20, 1952)
D. O. Vou. No- -------------------------------
urr
R0004001O 50-2
Bu. Vou. No- ---------------------------------
U. U.S. COST ------? ------ -- --------------
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No.
To
-------------------------------------------------------------------------
---------------------------------------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (State)
Anno
unt verified;
correct
No. and Date of
Date of Delivery
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
i
UANTITY
UNIT PRICE
AMOUNT
Order
or Service
schedule, ant
other information deemed necessary)
R
Discount Terms
Cost
Per
Dollars
Cta.
Costs
18, 692
64
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government
B/L No.
Total
18, 692
6
I certify that the above bill is correct and just and that payment has not been received.
(Payee must NOT use this space)
STATI NTL
Differences ---------------------------------
---------------
-----
ly)
-----------------------------------------------
---------------
-----
STATINTL
61M
----- -----------------------------------------
---------------
-----
Date __
---
---- --- --------- ------- ---------------
---- - - - -
e bills)
97___;___,
SIGN
ORIGINAL
CO SACT G ? ONLY
(Signature or initials) ---
Date
SAPC r 9
COPY OF 3
it-----------------------
voice Recd.
STATINTL Date --------------------------------------------------------------------------
STATINTL
I CChaeech, k $ No- _______________________ on _ dated _____________________________, 19 19 _____, for $-_ P____ayee _______---- --____________________ on Treasurer of the United States in
Paid by . favor of payee
- name named_ abbove.----------
----- -- ------ --
(94n orlclnnl only)
? When a voucher is at ned or receipted in the name of a company or cor oration, the name of the person
writin thecom an or r~pry ~ e vr. 0I'A IR F 4_0036IIR0O04O0'1-00$5$-2-
"Johri Doe Company,e LYbpft'iCl1G9~rdta , dry Yl~s aSkrrlt5y~be.
tIf the ability to certify and authority to approve are combined in one person, one signature only is nee- Title
essar ;otherwise the approving officer will sign on the line below "`Approved for $______-_____ ", and
over his official title.
 Standard Form o. 1036 a-Revisod s ~, I
Formprmed For Feel OIC j00 _ R00w40AMMANDU!M
Com trolle
6eptomber 7, 1960
(Gen. Reg. No. 61, 8upp? No. 11) 'Services Other Than Personal
41 CONTINUATION SHEET
COST REIMEtJR--RBLE Sheet No. ----- of Bureau Voucher No.
------------------------ ------ -- --------- bureau, , or or establishment)
burent)
ARTICLES OR SERVICES
supply schedule,
(Enter descript item number of contract or Federal
information deemed necessary)
Di rec Costa Properly Chargeable to
Contract A101 for the period. 3-12-56
thru 6-1o-56
Labor for the period 3-12-56 thru. 6-10-56
Overhead computed for the Electronic
Instrumentation Division at interim
rate of
a M aTTH 1 FF C ~~0360R000400100050-2