PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL
Document Type:
Collection:
Document Number (FOIA) /ESDN (CREST):
CIA-RDP64-00360R000600010135-6
Release Decision:
RIPPUB
Original Classification:
K
Document Page Count:
9
Document Creation Date:
November 17, 2016
Document Release Date:
July 29, 1999
Sequence Number:
135
Case Number:
Publication Date:
March 14, 1958
Content Type:
FORM
File:
Attachment | Size |
---|---|
![]() | 453.64 KB |
Body:
6tandard Form. No. 1034-Rovisod
I'arnp prescribed b? ~,9 ~Es~Y~,1G0'
oomptrollor Ce7-Yp7gJr oved Fo
September P
(Qen. Reg. No. 61, Su p. No. 11)
C ~ ~r D. a. Vou. No. ----------??-?--------------
0360 R0006000~~~ 135-6
~~~~ Bu. Vou. No. _--------'- ---`-------------__.-_
U. S. __ COST_ REIMBURSABLE
-------------------------------------------------------------------------------------------------------
(Department, bureau, or establishrnont)
Voucher prepared at -?------------------------------------------------------------------------------------------------------
THE UNITFfD STATES, Dr.,
(Cl]Ve place and date)
Payee's fdccount No_ ________________
To -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
and Date of
No
Data of Delivery
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
TY
AN
UNIT PRICE
AMOUNT
.
r
O
d
or Service
schedule, anr~ other inforrnmtion deemed necessary)
QU
TI
-
r
e
Coat
Per
Dollars
Cts.
Discount Terms
Cost
39,361
57
PAYMENT:
Complete ^
Partial ^
final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government B/L No.
Total
~~~ ~~
57
(Payed must NUT use this apace)
I certify that the above bill is correct and just and that payment has riot been received.
Differences ---------------------------------
---------------
---?-
STATI NTL (Sign original only)
Date
~1-1-~?J ~$ --- *Payee -------------------------------------------?-----------------------------
______ ________
____
-
__
ot renufred when a like eertNente I~ made by ixr7ee on ntinehed 610 or bias)
Amount verified; correct fez ___________
C .r
Pursuant to authority vested in me, I certify that this account ie correct and proper for payment.
SIGN
ORIGINAL
ONLY
{Signature or initials) ___
Date
t ---------------------------------------------------------------------------. __
(Authorized Certifying OIIlcer)
Title --??-------------------------------------------?---?-- Date -------------------------------------___---------------------------- ? --
THE REVERSE OF THIS FORM MUST BE ERECOTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
Check No. ________________________ dated _____________________________, 19_____,for $______________________________________ on Treasurer of the United States in tavur of
,~ , , , ~ payee named above.
rayee -----------------------------------------------------------------------.__
(Bien ori?lnnl only)
* When a voucher is or r ce1 to i~1ro na of com an amo ) p '? ~p
writing thecomPanYo1~~~~v~L1)(~~h~c~. ~ io1XJ49WSUWOla1'/aF'l~afr ' ~l~l[~ ~ V~=0~3~oRt~o0~00~o~$~r~s-~------__-..__.
"John Doe Company )ic J n Smith, ccrctary", or roasuror , a-s the case may bo.
_ (fitate)
t If the ability to certify and authority to approve are combined in mid person, one signature only is nee- Title _________________
essary; otherwise the approvin officer will si on the lino below ?A ~~ - ~~
g gn PProved for $___________________ ,and rc-zzsao-o
over his official title.
2051
~U. S. ----COST_RE~SABI,E----------------------------------------------------------- Sheet No. ------~=---- of Bureatt Voucher No. ------------
.~ __ __. ~_____.. .... ,...t.1.li~h mnn4\
'_ KSB' L,~W@~4/tea :'C.`NA=1C[7W'f34-(~36UK000~1*~~DU1VI
'
han Persona.
Services ?ther ~
ARTICLES OR SERVICES
(Enterdoacripta dfother'nEormationdeemed eceo?ary)pplys~hedul~,
Contract -~of Costs applicable to
All Systems
Direct Costs Properly Chargeable to
Contrati~t A^ ~ o / for Week F~iding
3/9/5$
Labor fo~ Week ~~ing March g, 1958
for Co nications Div1.SiOn
at irate ' m rates as= s
ch & Dev lapment
Other Co is -Per schedule attached
Total La or Qverh ~., and Other Gosts
G & A erase com uteri at interim
rate of
Total- Cots ~ STATINTL STATINTL
CONTINUATION SHEET
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