PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000500050148-9
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 3
• Document Creation Date: November 17, 2016
• Document Release Date: July 22, 1999
• Sequence Number: 148
• Publication Date: June 17, 1957
• Content Type: FORM

f9tanclard Fora! No. 1034-Revised
~, Form prescribed by yy~~~~
Comptroller CteJte~UrVved For
Sopte:nbor
(Glen, Reg. No. 51, S p No: 11)
(Amended February 20, 1962)
FF,~ R~ ~~ ~~ ~~~~ D. O. Vov. No- ---------------------------..-_
'R~'TH~i~~SI~NA~360 8000500058-9_____________
COST REINiBiJ~A.BLE
U. S. ----------------------------------------------------------~~--------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared of --------------------------------------------------------------------------------------------------------
(Clive place and date)
THE UNITED STATES, Dr., Payee's Accounf No. ________________
To -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (State)
ARTICLES OR SERVICES
UNIT PRICE
AMOUNT
and Date of
No
Date of Delivery
(Enter description item number of contract or Federal supply
ANTITY
.
Order
or Service
schedule; an~ other information deemed necessary)
QU
Cost
Per
Dollars
Cta.
Discount Terms
Costs
8, 319
.7+
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government B/I, No.
Total
~ 8, 319
,~~l
(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 c5ignoriginalotsly)
_
r ,
~-17_-~Z___ *Payee __
Date --------- ------------------------------------------------------------------------
-----------------------------------------------
------------------------?---------------------
---------------
---- --------
-----
-----
eertifioate net roavized when a like cartifioete i. made by aayee oa ?ttaehad 6iLL or bills)
Amount verified; correct r
~~
-.
Per ----- -------------------------------------- Title ----------------------------------------------
Contract No. A1Q1 Date Req. No.
P(:rsuant to authority vested in me, I certify that this account is correct and proper for payment.
BY ------------------------------------------------------------
SIGN
ORIGINAL
ONLY
(Signature or initials) ___ ___ ______________________________
------------
(Authorized Certifying Officer)
Title ---------------------------------------------------------- Date -------------------__------------------,---------------------?-----------?
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERYICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
Check No. ----------------?--_--- dated -------------------_-------_-, 19_____,for $_________-------_---_.._______________ (on Treasurer of the United States infa~ror of
lpayee named above.
t'81tl py
Cash, $------------------------? on -----------------------------------? 19-----? Payee -----------------------?=-----------------------------------------------
(6Ven or7?inal only)
? When a voucher is~lg~ F.~Qipty~ 1 Y a>tl P
writing the company dFl~titlsr~t~3lKi~e}ds~lShctlfe`cSpR~dkTliad~4tatI1R4ls, pear. Sl~i
"John Doe Company, ppe_r John Smith, Secretary", or "Treasurer", as the case may be,
f If the ability to certlfp and authority to a prove are combined in ono person, one signature only is nec-
essary; otherwise the approving officer well sign on the line below "Approved for $__________________ ', and
over hie official title.
~-40360ft-OE345{~OOv01~kSr-g-------------
Title -------------------------------------------------?--?-
1e-22900-+
 Approved For Release 2000/04/11 :CIA-RDP64-003608000500050148-9
METHOD OF OR ABSENCE OF ADVERTISING
1. Advertising in newspapers Yes ^ No ~.
2. (a) Advertising by circular letters sent to ___________________ dealers.
(b) .And by notices posted in public places Yes ^ No ~.
(If notices were not posted in addition to advertising by circular letters sent to dealers, explanation of such omission must be
made below.)
3. Without advertising, under an exigency of the service which existed prior to the order and would not admit of the delay incident to
advertising.
4. Without advertising in accordance with -----____-- - - - ------------------