PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400110044-8
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 17, 2016
• Document Release Date: November 1, 1999
• Sequence Number: 44
• Publication Date: October 2, 1956
• Content Type: FORM

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Cor eg. No. 51 Ter roved Fori~ NO 1 (C(Amended February 220, )1)
D. O. Vou. No. -------------------------------
AA~ 36OR0004001 44-8
AL Bu. Vou. No- --------------------- --
-------- COST RFII URSABLR
U. U.S.
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Clive place and date)
THE UNITED STATES, Dr., Payee's Account No. ------38 To
(Payee)
-------------------------------------------------------------------------------------------------------------------------------- -------
(Address) (City) (State)
No. and Date of
Date of Delivery
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
a
QUANTITY
UNIT PRICE
AMOUNT
Order
or Service
schedule, an
other information deemed necessary)
Discount Terms
Cost
Per
Dollars
Ca.
Colts
123
93
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government
B/L No.
Total
I certify that the above bill is correct and just and that payment has not been received.
(Payee must NOT use this space)
ATOTH
Differences ---------------------------------
-----------------------------------------------
---------------
---------------
-----
Date ____1-
-----------------------------------------
---------------
-----
-----
no)
Amount verified; correct for -----------
Per __- _____
(Signature or initials) --___Y____
________________
_____
T
N
SIGN
ORIGINAL
ONLY
STATOTH R THE REVERSE OF THIS FORM MUST RE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
STATOTHR
I Check No. ________________________ dated ___________________--_-______, 19_____, for $_____________-_---____________________ . on Treasurer of the United States in
Paid by favor of payee named above.
-------- ------ -- ---- ------
Cash, $---------------------- on ----------------------------------- 19-----. Payee
*When a voucher is signe or receipted in t e me of co pany or co a ' v' on
a f th~lq
n
~o
the
wrltin the corn an orcor
~
4 M A
,
"7ohn .
Company per o R'irdrlt)r~e th
yTSo.
tIf the ability to certify and authority to approve are combined in one person, one signature only is nec-
essary; otherwise the approving officer will sign on the line below "Approved for $------------------- ", and
over his official title.
(elan odclnnl only)
/~.~ p.~-
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)t~r~4-~VJ~~RV~4~~~0~4~-8 -
Title ____________________________
 Approved For Release 2000/04/12 : CIA-RDP64-00360R000400110044-8
STATOTHI
Approved For Release 2000/04/12 : CIA-RDP64-00360R000400110044-8