PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600010029-4
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 11
• Document Creation Date: November 17, 2016
• Document Release Date: July 29, 1999
• Sequence Number: 29
• Publication Date: December 20, 1957
• Content Type: FORM

tancI'rtr Form No. 1034-Aevisud
1"orm prescribAd :y....... & Ay" P8RC
{1Jen. Res too her, su No II) SERVICES OTHER THAN PERSONA
{... F
br
9n 705,9.1
e
u --_
D. O. Vou. No- -------------------------------
360R000600C19929-4
Bu. Von. No- ---------------------------------
U. S. COST REIMBURSABLE
-- -----------------------------------
(.a petrtmcnt, bureau, or establishment)
Voucher prepared at ------------------------- ---------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr.,
Payee's Account No- ----------------
T+o -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
----------------------------- -- --------------------
----------------------------------- ------ss)------------- (City) (State)
ARTICLES OR SERVICES
UNIT PRICE
AMOUNT
supply
number
item
(Enter
No. and Date of
Date of Delivery
information deemed necessary)
other
and
h
dule
e
QUANTITY
Order
or Service
,
sc
e
,
Cost
Per
Dollars
Cts.
Discount Terms
Cost
6,x1.21
02
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government B/1. No. Total
6,421
02
----- (Payee must NOT use this space)
I certify that the above bill is correct and just and that payment has not been received.
(Sign original only)
STATINTL
---------------
----
Date __ 1220 k
b'II
bill
)
---------------
----
o[
.
o notro?nirod when a like -61 to ie mode by payee on attaoC d
_
Amount verified; correct for ____
Per _
,
Title -------------------------------- -------------- (Signature or initials)
Date Req. No. Date Invoice Recd.
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
SIGN
ORIGINAL
ONLY
fi -------------------- ------------------------------------------
(,Authorizod Certifying Officer)
Title ---------------------------------------------------------- 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 -------------------------------------------------------------------------
(Sirn original only)
y,Qf~q~cQ yF~l~q o ame p
* When a voucher is/y AV
writing the company /C4LLhJ11t tUr)PCiDi9G U[4~AY~~ea4. a
"John Doe Company, per obn Smith, Secretary", or "Treasurer", as the case may be.
t If the ability to certify and 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.
~64;00360M0t600010029..4 --------------
Title -------------------------------------------------------
 Standard Form No. 1035a-Revised
Form prescribed by , Vg,V~ed For Rege ? v ~~y?
Co Lmpgtrontellmerb((flp~l ~ #Pr (nWr .r-v~-0
k?'[7vv~~rr~i ~TC~rrv
(Cien. Reg. No. 61, upp. No. 11) 'Services Other Than Person
CONTINUATION SHEET
OR0006UMEMORA MEMORANDUM
U. S. CQ - 1M--U - --------------------------------------------------------- Sheet No. 1------ of Bureau Voucher No. 10 5
(Department, bureau, or establishment)
d
er to
N%and
Date of
Delivery
ARTICLES OR SERVICES
E
i
AN-
UNIT PRICE
AMOUNT
O
d
or Service
(
nter descr
ption, item number of contract or Federal supply schedule,
and other Information deemed necessary)
IT Y
1TY
Cost
Per
Dollars
Cts.
Contract Costs applicable to
All Systems
Direct Costs Properly Chargeable to
Contract for the period 6/10
thru 12/1 5
Research &
Development
To
al
STATINTL
Labor for
the peri
6/10/57 thru 12/1/57
Sheet
# 2
Other Cos
ts - per
heat attached 1,164.$9
shee
# 2 2,210.62
Dotal Lab
3r and Ot
her Costs
G & A exp
ense comp
ted at interim
rate of
7
STATINTL
rotal Co
$ 6,421
02
pprove or a ease 2QO
O
, G
FF
 Standa;d Form N 1035a-Revis?
FormpreETJI veU For"~T e /f dr c# M6 60R0006~ flO.2 4 i1M
con3pBP mber70r38~6l0~ Other T ~y
(Glen. Reg. No. 61; e~upP. No. 11) ` Services Other i han r ersona
CONTINUATION SHEET
n Shed No. _2-_-_--_-_ of Bureau Voucher No. _1095---
U' S. 4Q -1-095---
(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
inforrmat on deemed necessary) supply schedule,
Labor 674.26
iv 067921 65.57
097060
107728 (7.24)
117060 86.57
117730 (5,90+-50)
Material
iv 067040 790-07
067922 234.52
077040 465.34
087040 2,349.79
097704 (43.18)
097040 140.00
117040 1,064.08
117730 (2,790.00)
TAN-
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62
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