PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600010038-4
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 17, 2016
• Document Release Date: July 29, 1999
• Sequence Number: 38
• Publication Date: December 20, 1957
• Content Type: FORM

Standard Form No. 10x4-1,ecked D. O. Vou. No_ ------------ -----------------
Form prescribed' byj~q^
8eptemb cT, d by roved For; Y~s~'~b 4 ' :P& ~ 03608000600 t 038-4
-(Gen. Reg. No. 51, Supp. No. 11) SERVICES OTHER THAN PERSONAL Bu. Vou. No. ---------------------------------
(Amended F'ebruary'' 20, 1952)
U. S. --------- C-ST - REIMBURSABLE------------------------ ----------------------------------------------------------
(. )Ppartment, bureau, or establishment)
i-
V cher prepared at ---------------- ..
---------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No_ ----------------
TO -----------------------------------------------------------------------------------------------------------------------------------
(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 to `/eight Government B/L No.
I certify that the above bill is correct and just and that payment has not been received.
STATINTL
Date _12120/57-- P.
ee --------------------------------------------------------------------------
.ot required when a like certificate i. made by payee an ettaahod bill or bile)
Per
No_ o_
Cc -ntruct
------ Title ----------------------------------------------
Date Req. No.
f Approved for $ -----------------------------------
By ------------------------------------ -----------------------
Title -------------------------------------------------------- -
SIGN
ORIGINAL
ONLY
70
.55
70
-55
.;agrd
------------------------------------------------
-----------------------------------------------
Amount verified; correct for -----
(Signature or initials
Date
---------------
---------------
---------------
t -------------------------------------------- ---------------------------------
(Authorized Certifying Officer)
Title --------------------------------------------------------------------------
Date --------------------------------------------------------------------------
Check No. ------------------------ dated ------------------------------ 19------ for $-------------------------------------- Ion Treasurer of the United States in favor of
Paid by payee named above.
{ Cash, $----------------------- on ------------------------------------? 19 ------ Payee -------------------------------------------------------------------------
(si?n original only)
? When a voucher is liked or recei tad '' a na f con an t' me o er '64=003f~O ReOo6ooOfOO-38-
writing the company or ~ ~I c It ioQur ~ y c r., Il w
"John Doe Company, per o n Sml h, ecrtary or reasurer , as li case may o.
t ,f the ability to certify and authority to approve are combined in one person, one signature only is nee- Title
essary; otherwise the approving officer will sign on the line below "Approved for $___________________ -, and
over his official title. 10---22900-6
 Standard Farm No. 1035a-Revised
Form prescribed by r
6epteer , pp. N~ed For R ?]G~~R000600010038-4
(Qon. Reg. No. 5 No. 11) Services Other Than Persona MEMORANDUM
CONTINUATION SHEET
U. S. -----COST _RE7 TjF ` ~ --------------------------------------------------------- Sheet No. ---I------- of Bureau Voucher No. 2QQ3---
No. and Date
Date of
Delivery
ARTICLES OR SERVICES
(Ent
r d
ti
i
It
f
b
QUAN-
UNIT PRICE
AMOUNT
v of Order
S
i
e
escr
p
on,
em num
er o
contract or Federal supply schedule,
l ITY
or
erv
ce
and other information deemed necessary)
Cost
Per
Dollars
Cts.
Contract System IV
Direct Costs Properly Chargeable to
Contract p for the period 12/9
thru 12/15/57
Research &
Development
T
al
STATINTL
Labor
or the We
ek Ending 12/15/57
G & A
ense c
puted at interim
rate o
Total (
osts
$ 70.
5
STATINTL
L
Approved For Release e x i5Ve
e 4