PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400120014-0
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 17, 2016
• Document Release Date: February 14, 2000
• Sequence Number: 14
• Publication Date: November 9, 1956
• Content Type: FORM

Form prescribed by
pr~q j(+O'fflV5 I~!11~1(a` 1~'(1R
Comptroller ler Ge penr __fOVed For. j~ `
(pen. Reg. Nom. 51 Supp. No. 11) SERVICES OTHER TH N
(Amended February 20, 1962)
400120014-0
U. S- --------------------------------------------- oal-m : -Ro ----------------------------------------
(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, anti other Information deemed necessary)
Discount Terms
PAYMENT:
Complete ^
Partial ^
Final ^
Shipped from to Weight Government B/L No. I Total
I (Payee must NOT use this space)
Date *Payee----------- -----------------------------------------------------------
to not squired when like eertideate i. made by payee on attached bill .,bill.)
Per
Contract No.A101
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
t --------
SIGN
ORIGINAL Title ----
ONLY
31
38
---------------
---------------------------------------- --------------- - -
Amount verified; correct for ----------- 3
(Signature or initials)-----------------------------------------
Title -------------------------------------+r--u-v- -----LUw Date -------------------------------------------------------------------------
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
Check No- ------------------------ dated -----------------------------, 19---__ for $ ------------------------------- on Treasurer of the United States in favor of
Paid by payee named above.
Cash, $------------------------- on ------------------------------------+ 19-----. Payee -----------------------------(ai3n----------origin,)----only) -----------------------------
e When a voucher is s*g@$ s5v i'es t j~Yin ~~iu'st pasi~ ' l lisnr R-0004oa~2oa44-0
writing the company or cbt'pb ert YI ----------------------------------
a
"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 Is nec- Title ---------------------------------------------------
essary; otherwise the approving officer will sign on the line below "Approved for $-------------------", and
18-229Wi
over Ti h s official title.
 Co m prescribed by_&Ved Ford
Corn troller (lone1 ~j
September 7.
(Gen. Ileg. No. Cl, app. No. 11) ervices t er all
U. S -------------------------------- Sheet No. _- 3'------- of Bureau Voucher No. `k? --
(Department, bureau, or establishment)
Date of
ARTICLES OR SERVICES
QUAN-
UNIT P
RICE
AMOUNT
No. and Date
Delivery
or Service
(Enter description, item number of contract or Federal supply schedule,
and other information deemed necessary)
TITY
Cost
Per
Dollars
Cts.
Contract AlOl - System IV
Direct Costs Properly Chargeable to
Contract AlOl for the month of
September, 1956
STATI
TL
Labor for the month of September, 1956
STATI
TL
Overhead computed for W ID Division
at interim rate of
Total Labor and Overhead
G & A expense computed at interim rate
STATI
TL
of
Total Costs
$ 31
38
00120014-MEMORANDUM
Approve or Release 200 //D5/O3 sC 64-0O OR000400120014-0