PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600010037-5
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 17, 2016
• Document Release Date: July 29, 1999
• Sequence Number: 37
• Publication Date: December 20, 1957
• Content Type: FORM

,:e4tttndttrd Form No. 1034-lte viscd
Form prescribed by
?
?
' U
?mseP em
era
' Se tebe r
oved For
(Gen. Reg. No. 5 , No. 11)
(Amended February 20, 1952)
D. O. Vou. No- -------------------------------
L
}$60R000600010037-5
THER THAN PERSONAL Bu. Vou. No. ______
U, S. cas! RE xSAB E
------ -. -------------------------------------------------------------------
Voucher prepared at _______________
- - ----------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr.,
To
Payee's Account No_ ----------------
----------------------------------------------------
---------------------------------------------------------
(Payee)
--------------------------
-------------------------- -
(Address) (City) -----
(State)
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)
Discount Terms
PAYMENT:
Complete ^
Partial ^
Final ^
Shipped from
(Payee must NOT use this space)
Differences
I certify that the above bill is correct and just and that payr,-ent has not been received.
STATINTL
Title
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
t Approved for $ -----------------------------------
SIGN
ORIGINAL
ONLY
----------------------------------------------
----------------------------------------------
Amount verified; correct for ---
(Signature or initials) ____ __/V
2)916
73
R,97_6-
73-
------- -----
1,2,7&._
Date Invoice Rec'd.
I --------------------------------------------
--------------------------------
(Authorized 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
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be shown; other classification optional)
Check No. ________________________dated _____________________________ 19
Paid by r ,for $ on Treasurer of the United States in favor of
payee named above.
Cash, $ - r on - 19----_. Payee
(Si,,, ------------------------------------
d
o?i nnl oalr)
Wh
en a voucher is signed or receipted in the name of a company or m r o o t w
of rs
writing the eompany or c e 11 M qc riy{
"John Doe Company, Pete~cArbr~yt[t ti
a "~
a b
a, o tIf 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.
I Use continuation sheet(s) if necessary
to _ Weight Government B/I. No. Total
P64=0O36ORO0060001-0037..5----------
Title
10-,L0?0-s
 y (nandard Form No. 1035a-Revised
Form prescribed by P~toj@**ff ~^g
mperro er Qenera],IIp. b . fCT/~ 0 000600010037-5
(L7en. RFF11eg. u 1QA or Re G7~r-[[--r~4
erviees Other Than Personal MEMORANDUM
CONTINUATION SHEET
Ua S. ___Q0SZ_RFT1uMTR&4U12 ----------------------------------------------------------- SW No. ------ of Bureau Voucher No. ---2002
(Department, bureau, or establishment)
No. and Date
. of Order
Date of
Delivery
or Service
Contract Costs applicable
to All Systems
Direct Costs Properly Chargeable to
Contract p for the period 12/2
thru 1215 57
Labor fo the per od. 12/2 thru 12/15/57
JV 117060
Other Co
is -
TV
17040
912.81
Jv
17717
(5.00)
Jv
17730
(287.76)
''otal Labor and (Y her costs
G & A excense computed at interim
rate of
STATINT
ARTICLES OR SERVICES
(Enter description, item number of contract or Federal supply schedule,
and other Information deemed necessary)
Approved For Release 2.000104Lt~ ,NVa -
376