PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600010011-3
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 17, 2016
• Document Release Date: July 29, 1999
• Sequence Number: 11
• Publication Date: January 14, 1958
• Content Type: FORM

StiandnrdT?ormNo. 1034-Revised
For n prescribdl b
Comptroller Gene 1 For
September 7, (Gen. Reg. No. 51, Sup k?oved . 11)
(Amended February 20, 1952)
B0360R00060002Q@911-3
Bu. Vou. No. ------------------------------
U. S. ----COST -REB-UR LE----------------------------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account 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
UANTITY
.
O
d
S
i
and other information deemed necessary)
schedule
Q
r
er
erv
or
ce
,
Cost
Per
Dollars
Cts.
Discount Terms
Cost
607
78
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government B/L No.
Total
607.
78
(Payee must NOT use this space)
I certify that the above bill is correct and just and that payment has not been received.
Differences ---------------------------------
---------------
---
STATI NTL (Sign original only)
Date - ---- ----------------- ---------- ------
-----------------------------------------------
--------- --------- ------- --- -----------
-
-
---------------
-----
r, uirod who.. like eertiseat. i. mad. by my.. on eEMehed bla or bilk)
erified; correct for ___________
Amount verified;
correct
Contract No. A - 10 0 Date Req. No.
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
Title ----------------------------------------------------------
- - --------------------
(Authorized Certifying Officer)
SIGN
ORIGINAL
Title ---------------------------------------------------------------------_--_
ONLY
Date ----------------------------------------------------------------------
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
Check No- ________________________ dated ------------------------------ 19------ for $______________________________________ on Treasurer of the United States in favor of
Paid by payee named above.
Cash, $------------------------+ on ------------------------------------- 19 ------ Payee -------------------------------------------------------------------- -__
(sig. original only) .
'When a voucher is si p ed or recei ted i ttnam . f a em any or~c p ij~ i o of er
writing the company or cAi Of erigilb It h ]*i3~ a
"John Doe Company, per`_Jd'01 n rnit acrettar~-v'' . or ^`2rreasurex as m e caso av e.
64-0036IIR000600010011-3-----------
Title ------------------------------------------------------?
 S ;aaclard 1CM-ul. No- 10358,-Revised
Formpreseribe fl oved FJ eF&aYe' QbMj
CowZP1tem Gener Q~ss~Ta+~ ~ ~~
M
YT1 ! I Q0360R00
pcmber 7, a
(Gen. Reg. No. 51, Sapp. No. 11) Services Other Than Persona
CONTINUATION SHEET
Sheet No. of Bureau Voucher No_ ------------
COST REIMBURSABLE 1 2020
No. and Date
of Order
Date of
Delivery
or Service
ARTICLES OR SERVICES
(Enter desccripta? diother nformation deemed necessary) number of contract or Federal supplyschedule,
to All Systems
Contract -f( Costs applicable
Direct Costs Properly Chargeable to
Contract 4-/r)/ for December, 1957
STATINTL
Labor fo the period 12/30 thru 12/31/57
Jv 1 7060 i
STATINTL
STATINTL
Approved For Release 2000/04/11 : CIA-RDP64-0036OR000600010011-3