PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400120021-2
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 4
• Document Creation Date: November 17, 2016
• Document Release Date: February 14, 2000
• Sequence Number: 21
• Publication Date: November 9, 1956
• Content Type: FORM

Standard Form. No. 1034-Revised D. O. Vou. No_ ________________________--_----
Form prescripe~d_ b~~y~
Comp!ner aeaaved For ~VANEM - 00120021-2
September 7, 9 0
(0'i. Reg. No. 51, tppp? No. 11) SERVICES OTHER THAN PERSO Bu. Vou. No_ _____________ 453
"(Amonded February 20, 1962)
U. S- _ COST f~ESMBt3RSABLE ------------------------------------------
(Department, bureau, or establishment)
---------------- -----
Voucher prepared at (Give place and date)
THE UNITED STATES, Dr., Payee's Account No_ ----------------
TO ---------------------------------------------------------
(Payee)
City) (State)
Adress)
ARTICLES OR SERVICES
No. and Date of Date of Delivery (Enter description Order item number of contract or Federal supply QUANTITY -
or Service schedule, and other Information deemed necessary)
Discount Terms
SAPG / a 7
COPY, I of 2?
PAYMENT:
Complete ^
Partial ^
Final ^ Use continuation sheet(s) if necessary
Shipped from to Weight Government B/L No. Total
(Payee must NOT use this space)
I certify that the above bill is correct and just and that payment has not been received.
STATINTL Differences ---------------------------------
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
SIGN
ORIGINAL
ONLY
(Signature or initials)
7,564
---------------
---------------
76
J V
Date = -- -------------
Title
THE 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)
19 for $_________ --_ on Treasurer of the United States in fad-c of
Check No. _ ---- ' --------------
----------------------- dated -----------------------------' payee named above.
Paid by 19 Payee
--=------------ -----------------------------
Cash, $------------------------r~on-------------}------------------'~ cs~~ or~a,a~ oar,
When a voucherxlyYf$di@/1Pi - n3LrY mwnlbtl~s 44tfs1f-aPPeaa?lYd,f ~~~1 ~~~1 _2
writing the company ddrr Corporate name, as'
e as "Treasurer", as the case may be.
John Doe Company, per John Smith, Secretary", or
tIf the ability to certify and authority to approve are combined in one person, one signature only Is nee- Title _______________________________________________________
essary; otherwise the approving officer will sign on the line below "Approved for $___________________ , and 1e-22eeD-F:
_ _m_,-, .rfi.
 Standard Form No. 1035a-Revised
.Form ppr~pc~ p~~k y~ p
For RsJs~~90~91~APS km
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