PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400110039-4
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 17, 2016
• Document Release Date: November 1, 1999
• Sequence Number: 39
• Publication Date: September 19, 1956
• Content Type: FORM

Standard Form No. 1084-Revised
dorm prescribed b , D. O. Vou. No_ -------------------------------
Comptroller Go
>~i'pk~rOved For R h e i6~/1~R NACK 4~$~.360R0004001102,19-4
September,
(~3en. Reg. No. 51 Supp. No. 11) SERVICES OTHER THAN PERSONAL Bu. Vou. No. ---------------------------------
b
ruary -, )
d Fe
COST REIMBURSABLE
U. S. ---------
----------------------------------------- --------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No. ___13--3-----
To -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (State)
Use
continuation s
he
s) if
necessary
Government B/L No. Total
Weight
ee must NOT u
s s
th
)
(Pa
pace
se
i
y
I certify that the above bill is correct and just and that
not
received.
payment has
been
Differences
STATOT ---------------------------------
No. and Date of
Date of Delivery
ARTICLES OR SERVICES
t
(Enter description item number of contract or Federal supply
d
QUANTITY
UNIT PRICE
AMOUNT
Order
or Service
schedule
, an
other information deemed necessary)
Di
scount Terms
Cast
Per
Dollars
Cts.
Cows
(11896
38)
PAYMENT:
Complete F1
Partial ^
Final F1
Shipped from to
1 89 6
---------------
-----
Date - -
-----------------------------------------------
-----=-----------------------------------------
---------------------------------------
-
-
---------------
------------
--
---- ---
-----
---
Amount verified; come for ----------
Pe
(Signature or initials) 't
By
Title _-__
STATOTH RTHE REYER
SIGN
ORIGINAL
ONLY
STATOTHR
Date SEP_ -9--856
I Check No. ________________________ dated _______________-------____-__, 19_____, for $--------______________________________ on Treasurer of the United States in
Paid by { favor of payee named above.
Cash, $-------------------------- on ------------------------------------? 19-----. Payee -------------- --------------- --------------------------------------------
!~ c (also on in,I only)
When a Voucher is aiA$(~~p ~(t~~ eor b'h,c;o e~V-4Q3~Q.~QQ4400110039-4
------------------------------
writing the company or cTo~ISrAT~en a~the Oapc t w h~e signs; must appear. For exam le:
"John Doe Company, per ohn Smith, Secretary", or "Treasurer", as the case may be.
t If the ability to certify and authority to approve are combined in one person, one signature only is nee- Title -------------------------------------------------------
s essarv~; otherwise the approving officer will sin on the line below "Approved for;______.____________", and
?o*.. i* m..;*i foie
Date Invoice Recd.
 Approved For Release 2000/04/12 : CIA-RDP64-00360R000400110039-4
STATOTHR
Approved For Release 2000/04/12 : CIA-RDP64-00360R000400110039-4