PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600010046-5
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 17, 2016
• Document Release Date: July 29, 1999
• Sequence Number: 46
• Publication Date: December 13, 1957
• Content Type: FORM

&ttLnrdn r-d Form No. g0~2-Rc~ isud
FJf?m t?oscribed by D. O. Vou. No. _______~_______________________
~" ?nmp~~'~r~a~~ved For--~~~eV~~~:~~~ '0 3608000600010046-5
September ,
(Qc~me>~od F~ ui;,BTrp a sb2>1> SERVICES ?THEIt THAN PERSONA Bu. you. No. ----1091--------------------
e y
>
U..S. -----CaS~' _RE~MI~JR,~A.~I,E ----=------------ ~-------------------------------------------------------------------
(i~epartment, buxcau, or establishment)
Voucher ~re~rared at ------~-------- -------------------------------------------------------------------------
((3ive place and date)
THE UNITED STATES, Dr., Payee's Account No. ________________
To -----------------------------------------------------------------------------------------------------------------------------------
(~$yee)
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (State)
No. and Data of
Dat? of Delivery
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
9
UANTITY
Q
UN3T F?cICE
AMOUNT
Order
or Service
schedule, and
otlxer information deemed necessary)
Discount Terme
Cost
Par
Dollars
Cts.
Cost
2,168
28
PAYMENT:
Complete ^
Partial ^
Final ^
--
Use continuation sheet(s) if necessary
-----
---- -
~ihipPed-from to Weight Government !3
/
L No.
-
To
tal
2
1.68
-
.28
_
_
__
_
(Payee must NOT use this space)
I cer?ify that the shave hill is correct and just and that payment has not been received.
=
Differences ________________________
STATI NTL
(sign original only)
C~^?77 ~ ----------------------------------------------
Date _1~,~1-~ _l__L_._ *Pa ee --------------------------------------------------------------------------'
---------------
-----
to nut rcaniied when a like oextifiaate is made by Dayea on atteohed bill or brie) i
Amount verified; correct Fer ___________
f
{Signature or initials) __-._________.__________________
SIGN
ORIGINAL
ONLY
invoice Recd.
(Authorized Certifying Officer)
Title -------------------------------------------------------------------------?
Title ------------------------------------------------------- - Date -------------------------------------------------------------------------?
TF1G REYE:tS): ?F THIS FORfi1 PdUST BE EXECUTED WHEN PUItCHASfiS AP.E MADE OR SERYICES SECURED W1'FHOUT WRITTEN AGREEMENT IN ANY FORM
Clteck No. ________________________dsted _____________________________, 19_____,fOr ~______________________________________ Jon Treasu.er of the United States in favor of
Paid by (payee named above.
Cash. $------------------------~ on ------------------------------------~ 19-----. Payee -------------------------------------------------------------------------
(Sien odrinnl nay?
' When a voucher is sig ed or receipted i t nam a ompany or Lo t a e of y~ rsp~
writing the company or c~el ~~~~ Pyt!~~~~~{S~ .I~ riT~IR
"John Doo Company, p r t c e~ r o a s e c se may o.
t It the ability to certify and authority to approve are combined in ono person, one signature only is nec-
essary; otherwise the approving officer will sign on the ilne below "Approved for ~___________________", and
over his official title.
t~ -s$sou-s
 ~Cand~.rtl ~oTm No. 108sa-~-Revised
~o*,m pprescribed byy ~'~blic V'ouclier ~o
Co~ep elez ~neral, U. 8. s 'a
(Qen. Reg. N~~~~i~ For R~,~.~0~~'le~, :a~~~03~~R000600~'~I~N~,~~
CONTINUATION SHEET
U. S. ______COST RE]MBIJRSABLE _______________ Sheet No. ____Z.______ of Bureau Voucher No. _ 10~] __
(Department, bureau, or establishment)
No. and Date
of Order
Date of
Delivery
or SorvIee
ARTICLES OR SERVICES
(Enter.description, item number of contract or Federal supply achedule~
and other information deemed necessary)
Contract -~o/ System III
Direct Costs Properly Chargeable to
Contract for the period 1118
thru 11 -. 57
STATINTL
the Week! Ending November 2~+, 1957
Overhead omputed or Carnmunications
Division tinter rates as follows;
Resear h & Deve opment - -
ProduC ion -
STATINTL
total Lab
G&Aex
rate of ~
r & Over ead
nse com ted 'nterim
STATINTL
STATINTL
Approved For Release ~O~Y?~4~~ 6r~IA~~R~64-00360R0006000~0~4~-3-V~~