PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600010092-4
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 8
• Document Creation Date: November 17, 2016
• Document Release Date: July 29, 1999
• Sequence Number: 92
• Publication Date: April 18, 1958
• Content Type: FORM

Standard Form No. 1084-Revised
Form prescribed b
C.Beg. 11 .tQeren,
8eptel r,?,yed For Re' ~~
(Qen Reg. No. b1,
(Amended February 20, 1952)
3&0R00060001 O%2-4
Bu. Vou. No- ---------------------------------
U. S. CC7ST__RE1?.7aF -----------------------------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Cive place and date)
THE UNITED STATES, Dr., Payee's Account No- ----------------
To ------------------------------------------------------------------------------------------------------
----------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (State)
No. and Date of
Date of Delivery
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
UANTITY
UNIT PRICE
AMOUNT
Order
or Service
schedule, and other information deemed necessary)
Q
Discount Terms
Cost
Per
Dollars
Cta.
Cost
38
677
85
,
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government B/L No.
Total
38
677
,
use this space)
NOT (Payee must
I certify that the above bill is correct and just and that payment has not been received.
Differences ---------------------------------
---------------
-----
STATI NTL (Sign original only)
----------------------------------------------
---------------
-----
We F ~ $ *Pa ee ----- ---
---------------------------------------------
-----------------------------------------------
---------------
-----
ena ,
t reeu 1rew d e eer
h Ck tiflnato is made by Parer on attached bill or ~ bille)
Amount
verified; correct for ----___---
S
No. Date Req. No.
t Approved for $ -----------------------------------
SIGN
ORIGINAL
ONLY
Date Invoice Recd.
(Authorized Certifying Officer)
Check No. ________________________ dated _______________-_____________, 19_____Ifor $__________________---_--______________ on Treasurer of the United States in favor of
Paid by payee named above.
l Cash, $ r on -- --- -- - -- - 19 - Payee
(sign original only)
' When a voucher is signed or receipted In the name of a company or corporation, the name of the person per 16-22900-0
writing the company or cor orate name, as well as the ca aeity in which he signs, must ear. Forexample: P6 360R000600010092-4
essaryotherwise the approving ofhcerwill sign on thline below Approved for $and ~ over his official title
.
Per ---- Title ---------------------------------------------- I (Signature or initials) '- ---------- -----------------
f
 Standard Form. No. 1O33a-Revised.
Form prescribed
Forr easY4 i4/ 9r. .OR0006 Q1Q0A92 4
(Gen. Rig. No. 5i, s No. x ervices Other Than Personal
CONTINUATION SHEET
U. S. -COST REIMBURSABLE _-_ - -------------------- .. .. . Sheet No. --..1 T,.-...... .. ----- -- ----.? _ ----- of Bureau Voucher No. _22.81...
ARTICLES OR SERVICES
(Enter description, item number of contract or Federal supply schedule,
and other information deemed necessary)
Direct Costs Properly Chargeable to
Contract - i for the period V7
thru L/l3 5
STATINTL
I JI/?IJINIL
i
Overhead for Co
computed at sate
Reso rch & De
Production -
im rates as follows:
schedule attached 11+,176.1
036019 4,135.7
038060 1,812.0;
U. S. GOVERNMENT PRINTING OFFICE 9- ^ 8
Approved For Release 2000/04/11 : GiA--l P64-00360R000600010092-4
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