PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600010072-6
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 17, 2016
• Document Release Date: July 29, 1999
• Sequence Number: 72
• Publication Date: November 8, 1957
• Content Type: FORM

1W Iz scri'e b.~ved For Release 2000/04/11 : CIA-RDP64-00360E QQ?,QQ~10072-6
Amount verified; correct for I g ?
(Signature or initials) ----- zGyi_______________ _
(Gen. Reg'. February . o. 11) ~.Ir SERVICES OTHER THAN PERSONAI?5"
Bu. Vou. No- ----- 1061------------------
U. U.S.
------- QQ5-T-_F-B1M 5AI3 --------------------------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
THE UNITED STATES, Dr.,
(Give place and date)
Payee's Account No. ----------------
TO -----------. ----------------------------------------------------------------------------------------------------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (city) (State)
No, and Date of
Date of Delivery
ARTICLES OR SERVICES
(Enter description item number of contractor Federal supply
UANTITY
UNIT PRICE
AMOUNT
Order
or Service
schedule, an other information deemed necessary)
Discount Terms
Q
Cost
Per
Dollars
Cts.
Cost
78
53
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government B/L No.
Total
7
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 (Sign original only)
Differences ---------------------------------
---------------
Date ---57--- * Payee --------------------------------------------------------- ----------------
-----------------------------------------------
---------------
-----
ot required wbee a like certificate I. made by payee oa attaohad bta or btlle)
SIGN
ORIGINAL
ONLY
f ----------------------- - -- ---------------------------------------
(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
United States in favor of
Check No- ________________________ dated ----------------------------- , 19_____,for $-------------------------------------- payee on Treasurer
namereasurerd of abotheve,
Paid by
Cash. $ ? on ? 19- Payee {
--------------------------------------?
(Siea orieinal sole)
e When a voucher is signed or recoipted in the name of a company or corporation, the namo of the person
writing the company or corporate name, as well as the capacity in which he signs, must appear. For example:
"John Doe Company, per John Smith, Secretary", or "Treasurer", as the case may be.
f If the ability to cegy tti~p ~~app~~r~~pvv~~~~qq~ i /i~~y p~~ qqp~1+ ~gnatuye-y i~g~q
essary; otherwise thcASl 1 Rb iI symoO R~:ll `IA~J L_. 1.~ lL~~f,
over his official title.
Per -----------------------------------------------------------------
64-G OROO0&OOO4O072-&--------------
 *and?Fd'orm No. 1035a-Revised
Fofm prescribed b T
T.
Comptroller For R
eptemb
SPMRI} X/ Eff
O 94-0 oR00069 7
O
Dv
ervices ter han ersonk
U. S. ----- COST--REIMBURSABLE ---- - - ------------------------------------------------- Sheet No. ----- L----- of Bureau Voucher No. 1061---
(Department, bureau, or establishment)
Date of
ARTICLES OR SERVICES
UNIT PRICE
AMOUNT
No. and Date
Order
Delivery
y
(Enter description, item number of contract or Federal supply schedule,
TITY
or Service
and other information deemed necessary)
Cost
Per
Dollars
Cts.
Contract A101 - System IV
STATINTL
Lo
To adjust Overhead from
current approved rate of
applicable to Computer Systems
Division for the period 1/1/57
to 9/30/57
1957
ubmit
ed
1957 Costs
Costs
compu
ted
Submitted
at re
ised
thru Vo. No. 1060
inter
'm rat
s
djustme
t
Labor
STATINTL
Overhea
TATINTL
G & A
Total
78
.53
v
r e lease 200-01.0,41.1
QJAKU z 8_ =0
1 v o
I
W
660
0
=
.
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