PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600010044-7
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 5
• Document Creation Date: November 17, 2016
• Document Release Date: July 29, 1999
• Sequence Number: 44
• Publication Date: December 6, 1957
• Content Type: FORM

5tan+),urdFormNo. Yfi34-Pevised
v Form Prescrirby~ed by D. O. Vou. No. _------------------------_---,
' Com6optombero~r`bved For- Y V~~~,~'D~~r0~,360R00060001~((0]44-7
(Cien. Reg. No. 51, Supp. No. 11) V~$C HER HAN PERSONAL Bu. Vou. No. ____10__.7_____________________
pp ~~ ~(+Amended Fetbrr{ua~ry~t20,_19~62)T~7 ~~p
CJ. S. ----_~i_~~l _ i~.CillriL7lJkit~.tiD~-------------------
..______________________________________________________________.._____ bAirl DV
(:~eparcment, bureau, ox establish)nent)
Toucher }~re~ared af ------------------ -----------------------------------------------------------?-----------------------
(givo place and date)
THE UNITED STATES, Dr., Payee's Account No_ ________________
To -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
(Aaaress> (o;ty> (state)
No, and Date of
Order
Date of Delavery
or Service
AR7 iCLES OR SERVICES
(Enter description item number of contract or Federal supply
schedule, anr~ other information deemed necessary)
Dascount Terme
PAYMENT:
Complete
Partial ^
Final
Sh'spped from
SIGN
ORIGINAL
ONLY
I certify that t;re above bill is correct and just and that payment has not been received.
STATI NTL (Sign original only)
(Payee must NOT use this space)
Differences --------------------------------
~?,923
~10~923
---------------
Amount verined; correct fcr ____ ____
~
D ~'~ ~
~
`
----____-- Title ------------------- -----_____I (Signature or initiala) ____ __~r~~i~~ _ y
-----------------
Date Req. No. Date invoice I2ec'd.
f APProved for $ -----------------------------------
By ------------------------------------- -----------------------
Title --------------------------------------------------------.-...
?~, ~Y G.i~ J~
SAPC .~v~~~+~
COPY / C)F ,c~i ,,
'j ----------------------- -------------------- -----------------
- ----------------
(Authoriaea Certifying Officer)
( Check No. ________________________ dated __--_---------_______-_______, 19_____, for $_-----_----_-_-___----__-__________-__ Ion Treaswer of the United States in favor of
Paid by { (payee named above.
Cash, $------------------------~ on ---------------------------------?-, 19-----. Payee -------------------------------------------------------------------------
~_~ (61?n oxi?inal onl-)
" Whcn a voucher is si ed or recei ted i t nam m om an Bohr o i ttj~t a o of ers
writingthocompanyor~I~p~~ytl~Qe ~ot`~~a~~?is~ec~iso ayfje.{~ 'F~,~ /~~} yy~~ /~. //~~a
"John Dom Company, r t t car ~ ~"' ~ ' ~' ~~wvJ~?R~vv~?~w~~~~-_----_----
lIf the ability to certitfy and authority to approve are comhined in ono person, ono signature only is nec-
essary; otherwise the approving officer will si~^t on the line below "Approved for $___________________", and Title __________________--_--___.___-_-____--___-_-_-____ __
over his ofiicial title. rs-zzsuo-s
 f3tan$t~r$ Form. No. 10~5a-Revised
Form prescribed by ~';~~Vp~~ _~^~? ,~~~? _OOR0006 7
Oompt_oiler qie dxb~/ed For 'd ZD 1'T? (~I ~'PoTIDUIl1~
BeptembLe~
((3on. Reg. No. 6I, n p. xo. II> @p~11C@? t er 'g'han L$~S?Il~
U. S. _______CQrS~I'__Rx'.TMRiTRS'A'F3TF--- ------ ----------- --------------------------------- Sheet No. _____~...__-- of Bureau Voucher No. __-~'Q~-
(Department, bureau, or establishment)
No. and Date
Date of
Delivery
ARTICLES OR SERVICES
QUAN-
(E
d
t
UNIT PRICE AMOUNT
_
of Order
r S
i
ntor
eacr
ption, Item number of contract or Federal supply schedule,
TITY
o
erv
eo
and other information deemed necessary)
Cost Per Doliara
Cte.
Contract A101 -System TI
Direct Costs Properly Chargeable to
i
Contract A101 i'or the period 11~18~57
thru 11~24~57
STATINTL
Research &
Development
ucti n
tal
V 1 /1 1 11 Y I L
rther Cos
s -Per
chedule attached (248.45),/'
~7V 1
7728 1.08 ,,,~
otal Lab
r, Overh
ad and Other Costs
& A exp
nse co
tad at interim
ate oi'
otal Cos
s
$ 10,923.
1
STATINTL
pprove or a ease . ,? , ~P, 4=~Q36IIR
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