PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600010087-0
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 3
• Document Creation Date: November 17, 2016
• Document Release Date: July 29, 1999
• Sequence Number: 87
• Publication Date: April 28, 1958
• Content Type: FORM

5tttindard Form.No. 1084-Revised
Form pprescribed by
Coffiptroller General, U. S. ~~JJ "
+' (C3on.,Reg No.6C1,~.VV1f.SiT~ For Rel~l~~i~~
? (Amended February 20, 19b2)
~'P~,~560R~000600010087-0 -------------
U' S
------------------------------- ----------------------------------------
(Department, bureau, or establishment)
Voucher ~re~ared of --------------------------------------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No_ ________________
To __________________________________________________Remo-Wooldridge _ Corporation
---- - --
-- -------------------------
(Payce)
----------------------------------------------------------Los _At~eles _ 45~_ California-------------------------
(AAArnac\ ,,..,
No. and Date of
Order
PAYIVIENT:
Complete ^
Partial ^
Final ^
Date of Delivery
or Service
INVOICE N0.
2077
2078
2079
2?80
2081
2082
ARTICLES OR SERVICES
(Enter description item number of contrast or Federal supply
schedule, anc~ other information deemed necessary)
I certify that the above bill is correct and just and that payment has not been received. I (Payee must I\`O~T use this space)
Date -------------------- ~ Payee ---------------
(This certlficato pot repaired when a like certtarata i~ made by Deyee op attaohad bia or bills)
Per ------------------------ ---- ------- Title ----------------------------------------------
Date Req. No.
Pursuant to authority vested in me, I certify that this account is correct and proper for p
~' APProved for $ -----------?-----------------?---
STATINTL
H
t
b
TH ERS I M MUST BE EXECUT HEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT R'RITTEN AGREEMENT IN ANY FORM
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be ahownl other classification optional)
STATINTL
SIGN
ORIGINAL
ONLY
~I.B
28,351
16,152
9,686 .
38,5$
Differences ________________
----------------
Amount verified; correct for ___________
---------------
---------------
---------------
(Signature or initials) _________
Date ------------------------------------ --- --- --
~
'
STATINTL
-- - ----
Check No. ________________________dated _____________________________, 19_____, for $_________________________________-_-__ on Treasurer of the United States in
Paid by
Caster $------------------------, on ---------------------------- ----? 19-----? Payee ----------------- ~ favor of payee named above.
? When a voucher is signed or recoipted in the name of a company or corporation the uam oft e o (s+en ortc;nal pay)
writing the company or cor rate na e s .For
"John Doo Com )an ~~~t1~, r t~
} If the ability to ce tPy anc2 adtho~~ o a ~ o? ~ '
essar otherwise the a y prove are combined in ono person, one signature only is nec-
Y~ pproving officer will sign on the lino below "Approved for $______-_ ", and
over his oiflcial title. ------------------------------------------------------
-
xa--2aaoo-s
97
66
81
8$
 i3taaadnrri Form No. 103-Itovised
?Form pprescribed by~ ~~jj
Comptroller (len~tL6roved For Y~~
~ September 7 1NJ r
t (Qen Reg. No, bl, Sup 19G2)I?
(Amended February 20,
-80~Gb11R00060~ 087-0
~i Bu. Vou. No. ___-?--~~ ---------------------
(Department, bureau, or establishment)
I~oucher prepared of --------------------------------------------------------------------------------------------------------
(Oivo place and date)
THE UNITED STATES, Dr., Payee's Account No_ ________________
To -----------------------------------------------------------------------?-----------------------------------------------------------
(Payee)
N
d D
t
f
te of Deliver
D
ARTICLES OR SERVICES
(Enter dcecription item number of contract or Federal supply
A
UNIT PRICE
AMOUNT
o. an
a
e o
O
y
a
i
S
schedule, anrf other information deemed necessary)
QU
NTITY
rder
erv
or
ce
Coat
Pee
Dollars
Cts.
Discount Terms
i
Cost
~
97
I
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
_
_ _
Shipped from ~ ~ ~to Weight Government [i/L No.
Total
1_I-g
(Payee must NflT use this space)
I certify that the above bill is correct-and just and that payment has not been received.
Differences ---------------------------------
---------------
-----
STATI NTL (Sign original only)
/ r
Date __ ~f-~~`-~.~--- *Payee --------------------------------------------------------------------------
squired a~Len a like cerGaaete fe made br aayeo on atteehed 6iLL or bill,)
-------------'---?----------------------------
---------' ----
_ _..---------
'~ ~ D
-----
-----
~r7
Per __ Title ----------------------------------------------
Contract No. -,/ ~ / Date Req. No.
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
SIGN
ORIGINAL
ONLY
(Authorized Certifying Officer)
Title ---------------------------------------------------------- Date -----------------?-------------------------------------------------------
THE REYERSE OF T111S FDRM MUST DE EAECUTED WHEN PURCHASES ARE MADE OR SERYICES SECURED W[THDUT WRITTEN AGREEMENT 1N ANY FORM
ACCOUNTING CLAS5IFICATION (Appropriation Symbol must be shown, other classificsrtion optional)
Check No. ________________________dsted _____________________________, D9____-,for $-------------------_------------______ on Treasurer of the United Skates in Favor ut
Paid by jl lpayee named above.
Cash, $-----------------------~ on ------------------------------------~ I9-----? .Payee ----------------------------------------------------------------___-_-
(67gn original udyl
? Whon a voucher is signed or roceipted in the name of a company or cor oration, the name oP the person
F Pcr --------------------------------------------??_---------------
writing the company or r orate ua.me as as the pa 't in whit s r. F m
'John Doe Company, ~~~i'r ~e~~?~a ~~~~~~ ? ~~~- P64z0~360R000600010087-0
}II'the ability to certl y n aut orlty o approve are cam me none person, oue sl natu're I o - It e __________________________________________________
ossary; otherwise the approving officer will sign on the line below "Approved for $______-_ ", and -----
----------- tc-zzooo-s
war his otFicial title.
 b
7 1
5
50
gCien. Reff? No. 81, uupP. No. 11) S~+ v~~''ioa7 f,~t11eIP A ~C~II ~~~~1?I~a~
C?NTINLIATI4DN SFYEET
U. ,~ __ COST__RE7NIBURSABLE ____-__-- _ .....__.-? ............. .... Sheet 1Vo, -.--~_-.__ o,~ ~ItYeall dTOliches~ 1iro..-~C77
(Department, bureau, or establishment)
~#alsrt;sr~ Form. P7o 108tie~--R?vise
FpTffi pC&SCr~"f101 r'AVe~ For~e~s~a~2A9.:~~~~,~46OROOO6OOO1 OO87-0
~
'
~f 8~
Com Strot ler
o
No. and Date
Irate of
ARTICLES QR SERVICES
UAIV-
UNIT PRICE
AMOUNT
of Order
Delieery
Enter descrl tion, item number of contract or Federal. su I schedule
ri . PP y '
ITY
or Service
and other information deemed necoaeary)
Cost
Per
1)olIars
Cts.
CC7ntraCt ~-~Q/ System IV
Direct Costs Properly Chargeable to
~~! for the period 3J31
Contract ~_
-
thra. ~+~67~0
STATI
Tl
Labor for the Week Ending 4~6~58
STATINTL
Overhead for Control Systems Division
computed at interim rate of _
-Total Labor and Overhead
G & A ex ens computed at interim
rate of
STATINTL
$ ~+8
97
Total Costs
1i
ff
R
.
Approved For Release 2000/04/11 :CIA-RDP64-003608000600010087-0