PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400120036-6
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 17, 2016
• Document Release Date: February 14, 2000
• Sequence Number: 36
• Publication Date: October 22, 1956
• Content Type: FORM

BtandardFormNo.l034-Revised D.O. Vou.No__________________ _
dorm prescri d b -
Corlltrtroller ae~~ir~ved For ~'e~~l~ ~i~#+~~b3fi0R000400120~6-6
September SERVICES OTHER THAN PERSONAL au. voLL. No. __________~________
(Qen. Rog. No. 51, Supp. No. Il) ______________
#Amonded February 20, 1982)
~.
U. S. ---------------------~ ~----------------------------------~~--------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared af ----------------------------------------- --------------------------------------------------------------
(Cive place and date)
THE UNITED STATES, Dr., Payee's Account No. ________________
To -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
(Adciress) (City) (State)
~APG ~~'`f.3
Gov J a>r .~
No
and Date of
Date of Delivery
- _ -
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
ANTITY
UNIT PRICE
AMOUNT
,
r
O
d
or Service
schedule, anrj other information deemed necessary)
QU
r
e
Cost
Per
Dollars
Cts.
Discount Terms
CQSfi#i
~~LL
P"
STATINTL
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary.
Shipped from to Weight Government B/L No.
Total
~~~--
sP ~~`r'
_
(Payee must NOT use this apace)
I certify that the above bill is correct and-just and-that payment has not been received.
Differences ----------------------?---------
---------------
-----
only)
STATINTL
-----------------------------------------------
---------------
-----
~
-
Date _
_ -`~------- ----
when alike o .)
-------------------------------------------
---
------- --_-,y
~ ~+i
---
_ _ _ ~/f________
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
to ~'---
SIGN
ORIGINAL
ONLY
(Signature or initials)
Dake
Title --------------------------------------------------------- Date --------------------------------------------------------------------------
THE REVERSE OF THIS FOAM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
STATINTL
STATINTL STATINTL
( Check No. ________________________dsted __________________________.__, 19_____, for ~______________._______________________ on Treasurer of the United Staten in
Paid by {t {favor of payee named above.
Cash. a------------------------? on --------------------------------?~_, 19-----? Payee ---------------?----?-----------?--------------------------
------------
reko orklnnl only)
? When s voucher is ~ i ~a Q ~lry~ ~~tysnje~y
writing the company or co p ate name, as well as the capac)ty n w is e s gns, mus appear. For examp e:
"John Doe Company, per John Smith, Secretary", or "Treasurer", as the case may be.
to the ability to certify and authority to appprove are combined in one person, one egnature only is nec-
essary; otherwise the approving officer will sign on the line below "Approved for;______.__:_________ ,and
fi4-OO~~QRDQ040D 1~OQ~~-&-------------
 gtan.dard Forn1 No. 103Sa-Revised
~ompptiro er r~r~o~-ed For F~e~~A~Ib~~Or(~A1W~~R8'~OQ~~OR00040~~~~-~U~
8eptem 9b0 ?
l
'
Data of
ARTICLES OR SERVICES
QUAN-
UNYT PRICE
AMOUNT
No. and Date
of Ordor
y
Deliver
or Service
(Enter description, item number of contract or F?daral supply schedule
.
and other Information deemed necessary)
TITY
Cost
Per
Dollars
Cta.
Contract A-101~stem IV -
Direct Costs properly chargeable to
Contract A-101 for the year 1955?
pverhead computed. for Contract A-101
TATIN
L
for the ear 1 at final a raved
~TATINT
rate -
TATINTL
Less -Overhead for 1955 previously
billed
~'
Total Costs
~~~'
?9
I
i
((ien. Reg. No. 61, Supp. No. 11) S~:rV1C~s ?ther ~
hari Pers?na
3 CONTINUATION SHEET
U. S. _____________________________-CU~iT REII~~P,URSABLE--------------------------------- Sheet No. --~------- of Bureau Voucher No.
(DOpartment, bureau, or ostablishment)
p~proveTFor Release 20D.Od~INT~N~IA-F~~~6a4-003608000400120036-6