PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400110080-8
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 17, 2016
• Document Release Date: November 1, 1999
• Sequence Number: 80
• Publication Date: August 8, 1956
• Content Type: FORM

13t,n:ndtt,rd Form No. 1034-Revised
Form pprescribed by {t
Cow +lralle General U. 8.
>~epte~~~e~ For ReLI e
(C3en. Reg. No. npp, a. Z ?
(Anaonded February 20, iD&2)
~~~R~HA~ERS~~gOR000400110(-8 _______________ _
tl. S. ?---COST L1~iBJ.t~i--------?---?----? - - - ------------------------?------------
_ ~? (Department, bureau, or establishment)
Yaucher prepared at --------------------------------------------------------------------------------------------------------
(Qtvo place and ante)
THE UNITED STATES, Dr?, Payee's Account No. _____~~'_47____
7'0
----------------------------------------------------------------------------------------------------------------------------------------
~, ,. _ (Address) (City) (8tate)
Plo, and Date of
Order
Date of Delivery
or Service
ARTICLES OR SERVICES
(Enter deacrtption item number of contract or Federal supply
schedule, anr~ other inEormat(on deemed neceuary)
Discount Terms
PAYMENT:
Complete
Partial
Final
Shipped from to
STATOTHR
STATOTHR
Title ------------------------------------
Date -----------------------
-----------------------?-?----------
STATOTH R
THE REYERSE OF THIS FORM MUST RE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FOAM
STATOTHR
Check No. ________________________dated ____________________________..,
~
19_____, far $______________________________________ on Treasurer of the United States in
Paid by
{ Eavor of payee named above.
Cash, $------------------------? on ------------------------------------?
14-----. Payee -------------------------------- ------------------ ----------------------
_._--- IB$n odd,,. ontr)
Title ---------------- ~j--------
?----------------------------
-----------------------------------------------
-----------------------------------------------
mount veri&ed; correct f
" When a voucher is signed or receipted in Cho name of a company or cor oration the name of the .crson
?
writingthocompan~o~py~ppgqtWp~~~~ggpp~~ ~[,$g y~.?a ~~ ~~cj}gg~Vc~
t~P Po~l~~~~1~
"John Doe Compa~,pd$r'rdl9htE~~!#, tiC~lar~-,~et~~~l4ret~,~'be
tdf the ability to cer ~fy end authority to a prow are combined in ono porsan, ono signature only is nee-
essar otherwise the approvln officer will a gn on the lino below "A ___", and
Y; g PProvod for $______._________
~_0-08-~OfZII0II40IIT'1-QOIIO-~8
Title _______________
'-??""?------?--------------------
over his official title,
 Approved For Release 2000/04/12 :CIA-RDP64-003608000400110080-8
STATOTHR
Approved For Release 2000/04/12 :CIA-RDP64-003608000400110080-8