PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000500030054-5
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 3
• Document Creation Date: November 17, 2016
• Document Release Date: July 22, 1999
• Sequence Number: 54
• Publication Date: February 27, 1957
• Content Type: FORM

ARTICLES OR SERVICES
(Enter description Item number of contract or Federal supply
schedule. ani other information deemed necessary)
Discount Terms
FOIAb3b
FOIAb3a
Use continuation sheet(s) if necessary
Shipped from to Weight Government B/L No. Total
(Payee must NOT use this space)
1certify that the above bill is correct and just and that payment has not been received.
Amount verified; correct r
(Signature or initials}. - ------------------------------------
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
Standard Form No. 1034-Revised
- Form prescribed by
Cumptrol or General, U. S.
SeptFor Rele
(Gen. Reg. 1
(Amended February 20, 1962)
0005000300515~
Bu. Vou. No- --------- - ---------------------
U. U.S. ----------- COST - RE-124BIMSABLE
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No. ----------------
To -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
SIGN
ORIGINAL
ONLY
t -------------------------------------------- ---------------------------------
(Authorized Certifying Officer)
Title
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANT FORM
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be shown; other classification optional)
( Check No_ ------------------------ dated ------------------------------ 19-----, for $-------------------------------------- on Treasurer of the United States in
Paid by j
1favor
f
d
b
.
o
payee name
a
ove.
l Cash, $ - on ? 19-----. Payee ---------------------------------
(ak. orisiul onb)
? When a voucher is signed or receipted In the name of aaccoompany or corrpgorraation,,, the name of the person
vrritin thecom P RY 1 E iWCf~tGCt k iC)