PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600010091-5
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 3
• Document Creation Date: November 17, 2016
• Document Release Date: July 29, 1999
• Sequence Number: 91
• Publication Date: April 18, 1958
• Content Type: FORM

i3tan.dard Form. No. iQ34-Rovised
Form prescribed by r T
Cemptrollcr Qe ra~q~ed For F~e
6optember (
~(Oeir. Reg. No. b1, u p o, i
? (Amended February 20, 19b2)
D. O: Vou. No- ------------?------?'-------
~(r$R0006000~$$~91-5
f3u. Vou. No. ----?-- - -----------------------
iJ, $'. __-- COST_REIMBURSABLE-----------------------------
-----------------------------------------------------------
(Department, bureau, or establishment)
I~oucher y~re~ared at ----------------------------------------------------------------------------------------------------~---
(Oive placo and date)
THE UNITED STATES, Dr., Payee's Account No. ________________
To ----------------------------------------------------------------------
-------------------------------------------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
(Addr~s) (city) (state)
No. and Date of
Date of Delivery
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
~
QUANTITY
UNIT PRICE
AMOUNT
Order
or Service
schedule, ainc
other information doomed necessary)
Discount Tarma
Coat
Per
Dollars
Cta.
Cost
9,686
81
PAYMENT:
Complete ^
Partial ^
Final ^
Uae continuation sheet(s) if necessary :
Shipped from to Weight Government B/L No.
Total
g
686
_
8]
,
?
I certify that the above bill is correct and just and that payment has not been received.
(Payee must NOT use this apace)
Differences -----------------------
--- ---
---- --
STATI NTL (Sign original only)
----- -
-
Date ---~'~ -- -- *Pa ee ---------------------------------------------?---------------------------
not reeuirad when a nke aerUaa.Ee i~ made by peyae on nLtsohed bia or b11i.)
Amount verified; correct for ___________
---------T --
~- / ~ /
~/
Contract No. - ~~? Date Req. No.
Pursuant to authority vested in me, I certify thak this account is correct and proper for payment.
~ APProved for $ -----------------------------------
By -----------------------------------------------------------
Title --------------------------------------------?------------
SIGN
ORIGINAL
ONLY
(signature or initials) ~~__________________________________
Date
(Authorized Ocrtifying Officer)
Title --------------------------------------------------------------------------
Check No. ________________________dotsd _____________________________, 19_____, for $__________--__-_______-_______________ t(ron Treasurer of the United States in favor of
Pairl by ~ tpayee named above.
Cash, $------------------------- on ------------------------------------~ 19---_. Payee ------------------------------------------------------------------------
(al?o ozi?Innl ody)
' When a voucher is signed or recoipted in tha name of a company or corporation, tho name of the person
writing tho company or corpJ~oe~ra~te name,~asyew~oll~arsyt~h~eoca a~cidty in which hf~e si s st 1 (~ ~Rg,
?John Doe Company, peA#QktU~jt"tb'Sollh bdd ~1~}~i~sri?~~~ano~ F1II~~pd
t If the abilit3* to cent f r a o o a r8 o s c-
essary; othorwise tho approving officer will sign on the line below "Approved for $___________________", and
ever his ofIIcial title.
------------
P6 -. 03608000600010091-5
i e -------------------------------------------------------
 Orm pre5erlbgQ by r ~j
Co ptroller Cien~ral, ~T~19oved For@a?@ ~ ~~q~? 9P'~G~R0006Q1~~1~-S~D~~
September
. (Glen. Reg. No. b1, Su P? o. 11 E'r~iCE'.S ~ ~Y? ~~1~Y1 ~~1?$?$lal
COddTIIViIATICIN SWEET
U. S. __ COSTS_ REIMBURSABLE - -------------- --_-__-- Sheet No. ____1 ___-- of Bureau Voucher No.
--------------------------------------
.,,~.,n.....~..4 - ----------__
No. and Date
of Order
Dato of
Daliverq
ARTICLES OR SERVICES
(Enter deacr%
tion
item n
b
f
F
d
l
QUAN-
UNIT PRICE
AMOUNT
or Service
p
,
um
er o
contract or
e
era
supply schedoale,
TITY
and other information dearned necessary]
Coat
Pas
Dollars Cta.
Contract %_,~~, ~ System VI
Direct Costs Properly Chargeable to.
Contract for the period 4/7
thru x+/13 5
STATI TL
STATINTL Research &
Development
Pr
ucti
n
To al
S
ATIN
L
Labor ~'
r the We
k Ending April 13 1958
STATI TL
Jv
38060
STAT
NTL STATINTL
Overhe
t
for Co
ications Division
~
~
;
`
compu
at inte
im rates as follows:
~ ~
?~
Rese
ch & De
c
elopment -_
Prod
tion -
r
+~
?~
~'~`~
~
~ ~ ,
Other C
sts - Pe
Schedule attached 2,930.00 / J `~
'~
~
~ `
'~ ~
~
~'
Jv
038019 2, 977.33 ~
0380~+o
`
?~ ~
'
~
go . oo ~
a
l
~~
~
i
,,
.
Total
bor, Ove
~
head and Other Costs ~
~ ~
~
: ~
'~
'
;?.
~
~` ~
G & A e
rate of
ease co
uted at interim STATI NTL
~~
~:~
`
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'
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,
.,~
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Total C
sts
STATI NTL ~
' ~
~
9 6$6 81.
..~F
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110 `~""~''~ 1 ~
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