PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600010009-6
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 17, 2016
• Document Release Date: July 29, 1999
• Sequence Number: 9
• Publication Date: January 14, 1958
• Content Type: FORM

-8tan ar&Form NQ. 1084--Revised
Forrh"pprescribed by
CompTroller GencFal, U. S.
(Gen. "WE-air Releas
(Amende February 20, 1952)
Payee's Account No.
U. S. _--COSTINIBURSABLE -------------------
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------- -----
THE UNITED STATES, Dr.,
To
r - _
0010009 0 $
AL-~0060Bu. Vou. No.
--------------------------
(Payee)
-------------------------
- ----------------------------
(Address)drasal --------------------------------------------------------------
..,,._-.
No. and Date of
Order
Date of Delivery
or Service
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
schedule, an e1 other information deemed necessary)
Discount Terms
PAYMENT:
Complete ^
Partial ^
Final ^
Shipped from to Weight Government B/L No.
Total
I certify that the above bill is correct and just and that payment has not been received. I (Payee must NOT use this space)
Differences
(Sign original only) --------------
- STATI NTL
Date *Payee --------- --------------------------------
s , ------------------
------- Title
(;ontract No. 6 10 + Date
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
t Approved for $ -----------------------------------
By ---------------------------------------
- -
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be shown; other classification optional)
-----
-----
Paid by Check No- ------------------------ dated ------------------------------ 19-----. for $-----
Jon Treasurer of the United States in favor of
Cash, $ ___ payee ee named d above.
------------------- ori.---------- ---------- 19-----. Payee ----------
-----------------
' When a voucher is signed or receipted in the namo of a company or corporat'o th of teieo odein?i aniri ----------------------------
writing the com n or cor ors a ~ee
s~ yt
1
"
,
p
Jh D Cegg~ ~t
~yp(~ 'P -1 103fOf2{~0060~ 0 -0OII96
sr -_
onoeon Nji ,471br~asi4cl~vh eZo htSs4 Pt -------------------
t If the ability to o a
y an am ority to approbi
ve are comned In one
over his person, one si nature onl is nec-
essary; otherwise the approving officer will sign on the line below "Approved for $____ g __ y
official title. ___________ ', and
SIGN
ORIGINAL
ONLY
Amount verified; correct for ___________
4co ,i
SAPC c3C6c,
OPY I OF ',;,-
4 521
(Signature or initials) ________
92
t ---------------------------------------------------------
Authorized Certifying Oftlcer)
Title
--------------------------- --------- ------------- Date
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
 Standard Form. No. 1035a-Revised
Farm preserib d b
Compt~rolle'be, oved FoFRe eis 4 4~? P YP c-O0~360R000C 8
SSeptember .
(Gen. Reg. No. 51, Unpp? No. 11) 3, rvices Other Than $ ersonar
CONTINUATION SHEET
U. S. ------QQO _.F-E A8 ---------------------------------------------------------- Sheet No. --1------- of Bureau Voucher No. 2018 (Department, bureau, or establishment) __ ___
No. and Date
of Order
Date of
Delivery
or Service
ARTICLES OR SERVICES
(Enter description, item number of contract or Federal supply schedule,
and other information deemed necessary)
Contract _ / 1 - j , System IV
Direct Costs Properly Chargeable to
Contract for the Month of
December, 1957
Labor fo
the per
od 12/30 thru 12/31/57
JV 1
7060
Other Co
is - JV
STATINTL
2701+0
iv
7060
JV
27065
Total'Laaor and other costs
G & A expense computed at interim
rate of
Total Cots I STATINTL
STATINTL
U. E. GOVERNMENT PRINTING OFFICE 0$-10--e$ee6-$
Approved For Release 2000/04/11 : CIA-RDP64-0036OR000600010009-6