PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000500030084-2
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 3
• Document Creation Date: November 17, 2016
• Document Release Date: July 22, 1999
• Sequence Number: 84
• Publication Date: February 28, 1957
• Content Type: FORM

86~iQa~ll'Form No. 1034-Revised D. O. Vou. No. __. ---------------------~___--
F'orm pprescribed b ~T/~ ~ni i t~~~~(~~~("~~:,~
t;omptrollor Qene~?yjj~ved For Re ,LI+r~CjYOYr l1ti}fG/?Nt~?~ i ;2 aP 1; 0030084-2 692
September 7
(Oen. Iteg. No. bl, s'3upp: No. 11) Bu. Vou. No_ _________________________________
(Amendod February 20, 1962)
U. S. -----------------------------------------------?-------------------------------------------------?-------------------------
(Depari.ment, bureau, or establishment)
i/oucher prepared at --------------------------------------------------------------------------------------------------------
(Olve place and date)
THE UNITED STATES, Dr., Payee's Account No_ ________________
To -----------------------------------------------------------------------------------------------------------------------------------
(Peyee)
(Address) (City) (State)
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
schedule. ar-s~ other information deemed neceuary)
Discount Term+
L certify that the above bill u correct and just and that payment ha, not been received.
Date ----~`--2957_-= *Payee --------------------------------------------------------------------------
P --------- Title ----------------- -- -------------------------
Contract No. - Date Req. No.
Pwauant to authority vested in me, I certify that this account is correct and proper for payment.
SIGN
ORIGINAL
ONLY
----------------------------------------_------
Amount verified; correct for ___________
(Signature or initials) ____ ~~,C__________________________
Date ~ Invoice Rec d.
t --------------------------------------------~---------------------------------
(Anthorized Certifying 019cer)
Title ---------------------------------------------------------- Date --------------------------------------------------------------------------
TNE REVERSE OF iHIS FORM MUST BE EIECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED NITNOUt WRITTEN AGREEMENT IN ANT FORM
Check No. --------------?-------- dated -----------------------------? 19____-? for ;-------------------------------------- on Treaawer of the United States in
Paid by j {favor of payee named above.
t Cabh, ~------------------------? on ------------------------------------? 19-----. Payee -------------------------------------------------------------------------
(aka midna oni>
? When a voucher is si,Vn~epid~or~regcpeip~t a~~j+nptithae,~$aQ~~ge off aic~aympan or co~rpoyrsattion, the name of the Parson P
writing the company orHt7b~ - "t S t ", _^'~_ I~~Tli '-dad m~Q~~l~' ~~~~~TJ~~~~~~o~-~----------------------------------?-
' John Dce Company, pe n Smi h, sere ary or reasurer as e e ma
to the abllityto certify and authority to a~prove ere combined In one person, one signature only is nee- Title _______________________________________________________
~~ssry; otherw ae the approving of8oer will s gn on the line below "Approved for $______.____________ _and
over his official title.
 Approved For Release 2000/04/11 :CIA-RDP64-003608000500030084-2
1. 1?dvertisiug ii1 reclvapapevs Ye:~ ^ NQ Q,
2.. (e) B.dverCisiiig Lrg circular Taffeta seat to ____---------____-- des.
fib) ~Lnd hp notices pe~sted in pehlie glares Yeas ^ No 0.
(I[ gatiree. wet aet pfd in additi~ to sdaetfdaing Dy cireuiar }~etLers sett, to dretisrs, expl,ar~ation c~? sxteia omission ffiust be
naueEe b~_)
~' lkDV'C~"f'tSiPi~
` 8clv`trtismrtg,
~,-The sixive form "Nie[hod of or l~~nce o# Advertising" is to be used w#xeu ureba