PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400110007-9
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 3
• Document Creation Date: November 17, 2016
• Document Release Date: November 1, 1999
• Sequence Number: 7
• Publication Date: October 1, 1956
• Content Type: FORM

Standard Form No. 1034-Revised D. O. Vou. No- -------------------------------
Form prq~c~r~ibed by_Y
Comptrollef{Ih7i ,(ry d For ReIRIVIN'6 f.B1 PROMP 08000400110 07-9
6. No. b, 1 5 . No. 11)
t c- . No. 51, supp
(Gen. Reg o SERVICES OTHER THAN PERSONAL Ru. Vou. No. ______
---------------------------
(Amended February 20, 1952)
U. S. -------------------------- COST -RE32 BU.E ------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at -------------- --
-------------------------------------------_
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No- ----------------
To -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
--------------------------------------------------------------------------------------------------------------------------------------- -
(Address) (City) (state)
No. and Date of
Order
Date of Delivery
or Service
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
schedule, and other information deemed necessary)
Discount Terms
PAYMENT:
Complete ^
Partial ^
Final ^
Shipped from
to
Use continuation sheet(s) if necessary
Weight Government B/L No. Total Z?
I certify that the above bill is correct and just and that payment has not been received.
Contract No.
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
(Approving Officer)
SIGN
ORIGINAL
ONLY
(Payee must NOT use this space)
Differences ---------------------------------
-----------------------------------------------
Amount verified; correct,for.r__-__-__-
(Signature or initials
Date
1,581.
55
1,581.
Title ---------------------------------------------------------- Date ------------------------------------------------------- STATOTH R
S TATOTH R THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
I Check No_ ------------------------ dated ------------------------------ 19_____, for S-------------------------------------- on Treasurer of the United States in
Paid by I. favor of payee named above.
Cash, . on ? 19 Payee - --- ----
-
rsrse winner only)
?Whenavouch &V Q rh ip 414ghj 1#-&RQ 4,003 0RD0D40A1'1_10D7_q-
writin the company r orporato name, as well as a capaci y n w is he s gns, mu aPPcar, or example:
"John Doe Company, per John Smith, Secretary", or "Treasurer", as the case may be.
tIf the ability to certify and authority to approve are combined in one person, one signature only isneec-- Title __________________________ -
essarotherwise the approving officer will sign on the line below "Approved for $---------------------- F: and
 Approved For Release 2000/04/12 : CIA-RDP64-00360R000400110007-9
STATOTHR
Approved For Release 2000/04/12 : CIA-RDP64-00360R000400110007-9
 Standl,rd Form NAP v ddFor tejease 2000/04/12 : CIA-RDP64-0060R000400110007-9
CJ'empetln fr scr eTal, U, $: Public Voucher or Purchases and
eptember 7, 1110 MEMORANDUM
(fen. Reg. No. 51, Supp. No. 11) Services Other Than Personal
CONTINUATION SHEET
COST REIMB NSABLE ----------------- Sheol No. -a -------- of Bureau Voucher No. ---404---
(Department, bureau, or establishment)
and Date
No
Date of
ARTICLES OR SERVICES
tUAN-
UNIT PRICE
AMOUNT
.
of Order
Delivery
(Enter description, item number of contract or Federal supply schedule,
TITY
or Service
and other information deemed necessary)
Cost
Per
Dollars
Cts.
CK.# PAYEE
51555 PETTY CASH
12.
90
Approved For Release 2000/04/12 : CIA-RDP64-0036OR000400110007-9