PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600010002-3
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: November 17, 2016
• Document Release Date: July 29, 1999
• Sequence Number: 2
• Publication Date: January 22, 1958
• Content Type: FORM

StaiiidrardformNo..1034-Revised
Forty prescriberd by
Comptroller Gener 1, U. S. LIC VOUC
OUC
September Z rpved For
(Qen. Regt Na,. b1,
(Amended February 20, 1952)
360R000600010002-3
U. S. -------------------------------------------------------------------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No. ----------------
To ---------- Ramanlia alslridge__OQrpQrat 4 --------------------------------------------------------------------
(Payee)
--------------- 8B2Q_Ilallance.-Avenue---------------- 1QS_-XNGELES j.--CALIE0 N1A-------------------
(Address) (City) (State)
No. and Date of
Date of Delivery
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
i
QUANTITY
UNIT PRICE
AMOUNT
Order
or Service
schedule, ant
other information deemed necessary)
Discount Terms INVOICE I 13ERS
Coat
Per
Dollars
Cts.
2013
756
77
201
678
56
2015
558
13
2016
529
47
2017
918
26
PAYMENT:
2018
'f 527
92
Complete ^
2019
7, 282
Partial ^
2020
607
78
Final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government
B/L No. Total
1ST858
I certify that the above bill is correct and just and that payment has not been received.
(Payee space)
must NJT use this
Differences ---------------------------------
---------------
-----
(Sign original only)
-----------------------------------------------
---------------
-----
Date -------------------- *Payee -------------------------------------------------------------------------
-----
-----------------------------------------------
---------------
-----
(Thi. eertift-te not required when a like oortlfoete le mode by soyee oa ottuhed bill., bill.)
Amount verified; correct for ----------
---------------
-----
(Signature or initials) -----------------------------------------
Pursuant to authority vested in me, I certify that this account is correct and proper for
f Approved for $ -----------------------------------
By --
Title
SIGN
ORIGINAL
ONLY
STATINTL
STATINTL
(Contracting 0fficfr)
Date --------------------------------------
----------------------------------
THE-REVERSE OF THIS FORM MUST BWEXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
STATINTL
I Cash, No- ________________________ dated ------------------------------ 19_____, for $-------------------------------------- on Treasurer of the United States in
Paid by j , favor of payee named above.
t , $ on - ? 19 Payee --ign----------------------------
------------
(6 orlalnal only)
? When a voucher is signed or receipted in the name of a company or corporation the name of the Orson
writing the company or cor l y; I o e
"John Doe Company, pe f ec taky ra 'FW6#e t2 QQQ10*41 ? A04
t If the ability to certify an authority to approve are combined in one person, one signature only is nec-
essary; otherwise the approving officer will sign on the line below "Approved for $------------------- , and
over his official title.
bP64 0O36OR0II0600010002=3---------
Title