PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600010144-6
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 5
• Document Creation Date: November 17, 2016
• Document Release Date: July 29, 1999
• Sequence Number: 144
• Publication Date: February 28, 1958
• Content Type: FORM

Standard Form. No. 1034-Revised
ept pproscribe by fe
Form
S. l A 7 .mod[ ` LIC r l}J~
Ciimptrollor Qe Al UW1199
September ~ ed F e
(G.. Reg. No., bl, S u
U. S. -----COST--REIMBURSABLE ---------------------------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at ------------------------------------ -------------------------------------------------------------------
(Give. place and (late)
THE UNITED STATES, Dr., Payee's Account No. ----------------
To ----------------------------------------------------------------------------------------------------------------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (State)
No. and Date of
Order
Data of Delivery
or Service
D. O. Vou. No- ----------- ----------- --.--.
360R00060001&t44-6
Bu. Vou.. No- --------------------------------
5APC?
'OPY I OF
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
schedule, and other information deemed necessary)
Discount Terms
PAYMENT:
Complete
Partial
Final
Shipped from
Weight Government B/L No. Total
(Payee must NOT use this space)
I certify that the above bill is correct and just and that payment has not been received.
STATI NTL (Sign original only)
Date 2 28 8 * Payee ------ ke----- -------------------------
5- m de requ fiired red whem n a like aertlaeete I. mad,
de by nerve an attacked bill or bills)
------ Title ---- --
Contract No. A-/p ( 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 REVERSE OF THIS FORM MUST BE EXECUTED 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 favor of
Paid by payee named above.
Cash, $ + on ------------------------------------ 19. Payee -----------------
(Bin original oni)
When a voucher is 'fined Or recefptc l ho na o4 company o on 'me - 0 -J~6 -GR000VV 1 1'F'F '6001D1*V~~ ~i 7~ -V -
writing theCompany o y peel thA i`Ea lc7gY~ 90 p1} I ar. ~ /1-Ti 0-
"John Doe Company, p~i~mStlf cePeIWI "i , SS c b .
f If the ability to certify and authority to approve are combined in one person, one signature only is nec- Title -------------------------------- --- - "' `
essary; otherwise the approving officer will sign on the line below "Approved for $-------------------", and
over his official title. 16-22900-16,
Use continuation sheet(s) if necessary 1 1-1
WU~
Differences ---------------------------------
Dollars i Cts.
28, 063
.68
28,063
---------------------------- -----------
-------- ----- ---
Amount verified; correct for_---r---- __
(Signature or initial
 Standard Form No. 1035a-Revised
?? Form prescribed b '7 ?v Q1, i
mtr?l erred Fore vv}v(`}IJ~~ ~1 PAdOR00060ND,U
(Gen. Reg. No. Cl, 8 pp. No. 11) erv?aces t er T an ersona
U. S. -----COST-REIMBURSABLE ---------------------------------------------------------- Sheet No. -----1----- of Bureau Voucher No. _2011-0-__
---------------- ---------
(Department, bureau, or establishment)
Na. and Date
Date of
Delivery
ARTICLES OR SERVICES
QUA
Y-
E
i
UNIT PRICE
AMOUNT
of Order
i
S
(
nter descr
ption, item number of contract or Federal supply TIT schedule TIT
Y
or
erv
ce
and other information deemed necessary)
Cost
Per
Dollars
Cts.
Contract q rol Costs applicable
I
I
to All Systems
Direct Costs Properly Chargeable to
Contract for Week Ending
2/23/58
STATINTL
Research &
STATI
TL STATINTL Development Pr
ucti
n
To
al
abor for
deek Endi
g February 23, 1958
verhead c
mputed
r Communications
vision a
i
interi
rates as follows:
Researc
& Deve
merit
Product
ion -
Cher Cost
- per s
chedule attached
otal Labo
r, Overhe
ad and Other Costs
& A e
se com u
ted at interim
,
ate of
28,063
.68
STATINTL
Approved or Release N
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