PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400110040-2
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 17, 2016
• Document Release Date: November 1, 1999
• Sequence Number: 40
• Publication Date: September 19, 1956
• Content Type: FORM

Form proscribed bT roved Fo 1#~11
Come General
7, 19 No. ( (4 nonded February 0 982)1)
D. O. You. No. ---------------------
360R000400110040-2
Bu. Vou. No- ---------------------------------
U. S. _ ------------------------- A ET -------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No. ____1.34 ---
1,0 -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
--------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (State)
No. and Date of
Order
PAYMENT:
Complete ^
Partial ^
Final ^
Date of Delivery
or Service
Shipped from to Weight Government B/L No. I Total
(Payee must NOT use this space)
COPY OF 3
SAPC( (O9 I I
7k
STATOTHR
STATOTHR
------------------------------------------------
Amount verified; correct for _- ----- A
$ 74
---------------
---------------
---------------
58
(Signature or initials) ------- 2?_-------- _____________
Contract No. #3.01 Date Req. No.
Pursuant to authority vested in me, I certify that this account is correct and proper for paym
SIGN
ORIGINAL
ONLY
STATOTH qHE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be shown; other classification optional)
STATOTHF
Check No. ------------------------ dated ------------------------------ 19 ------ for $-------------------------------------- on Treasurer of the United States in
Paid by I. favor of payee named above.
{ Cash. $------------------------? on ------------------------------------? 19 ------ Payee ------------------------------- -----------------------------------------
(sign oriainnl only)
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
schedule, and other information deemed necessary)
Discount Terms
When a voucher is signpdor receij ted in hQ-name qua company or e r or t1on~~the name of the =anon
-E ex- T ~+/~a /~ n fi /~040 K
writing the company or cot7df"iFDl kh 1t1 CMf Ce~dl~tl ~9 ~(r}11R1pt~ Fo~ AP1 64
-0U3 V V RU V 040 V 1 V -L
"John Doe Company, perd 3mIL1, c tarps t'", br fsT t 1'740
tIf the ability to certify and authority to approve are combined in one person, one signature only is nec- Title -------------------------------------------------------
essary, otherwise the approving officer will sign on the line below "Approved for $---------------------- and
over his oficial title.
 Approved For Release 2000/04/12 : CIA-RDP64-00360R000400110040-2
STATOTHR
Approved For Release 2000/04/12 : CIA-RDP64-00360R000400110040-2