PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000500030050-9
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 3
• Document Creation Date: November 17, 2016
• Document Release Date: July 22, 1999
• Sequence Number: 50
• Publication Date: February 27, 1957
• Content Type: FORM

Standard Form. No. 1O84-Revised
FKm prber7edby
Colaptroller Gene1i 1 II.
September 7, pu ved For Re
(Gen. Reg. No. 51, Supp, o. 11)
( S I!((r/j}xr }MJ-,~, 4}j~till
(Amended February 20, 1952)
OST
E
URSA
NEW Q~,500030050-9 662
Bu. Voss. No_ _________________________________
C
R
INID
BLE
U. S. --------------------------------------------------------------------------------------------------------------------------------
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No_ ________________
------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (State)
No. and Date of
Date of Delivery
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
UANTITY
UNIT PRICE
AMOUNT
Order
or Service
schedule, and other information deemed necessary)
Q
Cost
Per
Dollars Cts.
Discount Terms
Costs FOIAb3a
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.
Differences ---------------------------------
-
FOIAb3b (Sign original only)
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___~~-:27-
fJate -----------------------------------------
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uired when o like eertiee.t. i. aod. by Pyre
on ottoohed bill
bill.)
by
o.
Amount verified; correct for
_________
a
Per _ Title ---------------------------------------------
(Signature or initials) ________________
.______________
Contract No. Al nl Date Req. No.
Pursuant to authority vested in me. I certify that this account is correct and proper for payment.
t Approved for $ -----------------------------------
(Authorized Certifying Officer)
SIGN
By ------------------------------------------------------------
ORIGINAL
Title
ONLY
Title ----------------------------------------------------------
I Check No. ________________________ dated _____________________________, 19_____, for $-------------_________________________ on Treasurer of the United States in
Paid by { favor of payee named above----------
-------- Cash, ------------------------ I on ------------------------------------? 19 Payee
---
(elan mtiinal oNy)
e When a voucher is signed or receipted In the name of a company or cor ration, the name of the person
---------------------------------
writingthecompanyorcoA DIM ~vf6liasylQls~~Eagitd'dp~![ILiIA ~eS b~FA~uD 6~`6RDD-OTJD-00-3-O~TJO~"
"John Doe Company, pe fLti'' c1 t~! ''~1?t ~1Ye`~s~f 9F?~'t
}If the ability to certify and authority to approve are combined in one person, one signature only is nee- Title ____________________________
essa ; otherwise the approving officer will sign on the line below "Approved for $___________________", and -"'"?
over hisoffictal title.
 Approved For Release 2000/04/11: CIA-RDP64-0036OR000500030050-9
1. Advertising in newspapers Yes ^ No Q.
2. (a) Advertising by circular letters sent to ----------------- deniers.
(b) And by notices posted in public places Yea ^ No ^.
(lf natk-w were ant ed in add:ti to advertising by circular letters sent to daslers, explanation of such omission must be
made below.)
-Wvertising.
4 Without adeertiairrg in aecordame with ------------------------____--
5,,, tl t a4ve sing;, it being lmpracticablc to stove Qoa$,peti tlon beeauaaa of ---------------------------------------
-------------------------------------------------------------------------------------------------------- -------------- ------- ---------- ------ -- ?-----
mere state in detail tba nature of tttr e y at a+oar s ahem under which the sxering of cwnpetitton was impracticable ender 3 and 4)
NoTE.-Tin above form "Method of or Aieaence of Advertising' is to be used when purchaiies are made or services secured under
ppzWer authority without written agreement in any form. In c Ae of a written agreement (formal contract, proposal, and acceptance, or
least formal agreement) Standard Form No. 1Oafi---Revised should be used for abstracting the method of or ab nee of advertiffing and
award of contract. (See General Regulations Na. 51, as amended.)
Approved For Release 2000/04/11: CIA-RDP64-0036OR000500030050-9
%W10' %WO1
 Standard Form No. 1035a-Revised
Form prescribed by
Comptroller ~~ed For Re ks@liooV/ouehet1fdP l &QBg0.0501030050-9
8eptemb
(Gen. Reg. No. b1, 6upp. No. 11) Services Other Than Personal MEMORANDUM
CONTINUATION SHEET
U. S. _____ COST REIMBURSABLE ------- Sheet No. ______ of Bureau Voucher No. 62
------MB ------------------------------------------------------------
(Department, bureau, or establishment)
FOIAb3a
ARTICLES OR SERVICES
(Enter description, item number of contract or Federal supply schedule,
and other information deemed necessary)
Direct Costs Properly Chargeable to
Contract AIOl for the period 12/l/56
thru 12/31/56
Overhead computed for Communications
Division at interim rate of
of
Other Costs
Per schedule attached
Adjustments:
JV 126901
JV 126914
iv 126123
Total Labor, Overhead and Other Costs
Approved For Release 200(UOAL 7NT.P.CIA--kWP - -