PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600010049-2
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 6
• Document Creation Date: November 17, 2016
• Document Release Date: July 29, 1999
• Sequence Number: 49
• Publication Date: December 13, 1957
• Content Type: FORM

Standard Form No. 1034-Ire vised
Form prescribed by
~
ai
nscPtembo j
~ygd For Rat
G
R
(
en.
eg. No. 5 , o. 1
(Amended February 20, 1962)
D. 0. Vou. No - ''PGPO'60 8000600010049-2
i
ER THAN PERSONAL W* Bu. Vou. No. ------1094
U. S. ----- C-0m-RE TtE
----------------------------------------------------------
(:)eparimeut, bureau, or establishment)
Voucher prepared at _________________..___________
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No.
To
-----------------------------------
-----------------------------------
-------------------------------------
(Payee)
No. and Date of
Order
Date of Delivery
or Service
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
schedule, anti other Information deemed necessary)
Discount Terms
PAYMENT:
Complete ^
Partial ^
Final [i
SAPC ."G.~i ?tv
COPY / OF,ci
Shipped from to Weight Government B/.L No.
I certify that the above bill is correct and just and that payment has not been received (Payee must NOT use this space)
STATI NTL (Si, original only)
l.ontract No. _ /?(- f 0 / Date Req. No.
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
SIGN
ORIGINAL
ONLY
Date Invoice Recd.
t ------------------------------------------------- ----------
(AUthorized Certifying Officer)
Title
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 , for $ fen Treasurer of the United States in favor of
I Paid by ----------------
Cash, $---------------------- on ------------------------------------ 1 19 ------ Payee ---------------------------- tpayee named above.
---
(aian only)
When a voucher is signed or receipt-- in the name of a company oriainel or r o a ' i. e o of rs
writing the company or coop p~ @~y] c
P64~0o-36GR0OO6OOO140499~2----____--
"John Doe Company, p~"X~ifiElY LeEtkt For" Y7( 9S6fLts t'iSo~a, ay 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
Titie ------------------------
over his official title.
26, i1
2 ,
---------------
---------------
---------------
69
------------------------------------------------------
~tn not reyuiro- w-cn a like certif-ate la weds by p,-, on rts---- -- - -- ------------------------------------------ _-___---
Amount verified; correct for
I
----------------------
tii-22ooo-a
 l tandard lrorm No. 1038a--Revised
Form rosoribod b tic \
' ` SptembAn"6ed For'Re4ease
X/
0 OR0006 QMMft&DUM
Xrb Werso g an k,--
U . S . ----CQST_.REIMBIRSABLF ------------------------------------------------------------ Sheet N o-- - - - - - ____ of Bureau Voucher No. _ 19 4--
(Department, bureau, or establishment)
No. and Date
Date of
Deliver
ARTICLES OR SERVICES
E
AN-
QU
UNIT PRICE
AMOUNT
of Order
Y
(
nter description, item number of contract or Federal supply schedule,
TITY
TY
or Service
and other information deemed necessary)
Cost
Per
Dollars
Cts.
Contract -(OI System IV
Direct Costs Properly Chargeable to
Contract /p for the period
11/25/57 thru 12/1/57
Research &
-
Development
oduct
on
ta:
STATINTL
Labor for
Week. En
'ng December 1, 1957
Overhead
omputed
or Communications
Division
it inters
rates as follows:
Resear
h & Deve
o ment -
Produc
tion
STATINTL STATINTL
Other Cos
s - per
chedule attached
Total Lab
r, Overh
ad and Other Costs
G & A ex
nse com
d terim
ate of
otal Cos
s
STATINTL
26)A7
0
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