PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600010145-5
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 17, 2016
• Document Release Date: July 29, 1999
• Sequence Number: 145
• Publication Date: March 10, 1958
• Content Type: FORM

Standard Form No. 1034-Revised
;Ct+mPtr~ller ler Gr
Form Ge ived For ONW216 t Pt
%7 %7
beptemb SERVICES OTHER THAN PERSO
Tteg. Na. 51 1, Supp. No. 11)
(Clen:,,
Amonded February 20, 1962)
D. O. Vou. No- ------- ---------------------
360R000600018145-5
Bu. Vou. No- ----------- 41
--------------------_-
U. S. ---_ COST--REIMBURSABLE ------------------- -------------------------------------------------------------------
(Lcpertment, bureau, or establishment)
Voucher prepared at --------------- ----------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No- ----------------
To -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (State)
ARTICLES OR SERVICES
No. and Date of Date of Delivery (Enter description item number of contract or Federal supply QUANTITY
Order or Service schedule, and other information deemed necessary)
Discount Terms
UNIT PRICE
AMOUNT
Cost
Per
Dollars
Cts.
Cost
6,742
,43
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government B/L. No.
Total
6, 742
V3
(Payee must NOT uue this space)
I certify that the above bill is correct and just and that payment has not been received.
Differences ---------------------------------
---------------
----
STATI NTL (Si.. original only)
/ ----------------------------------------------
3! dl *
Payee
t
D
- ---------------------------------------------
---------------
-----
-
a
e --
-------------------------------------------------------------------------
, oir.:d when a Ilk. oortiricato 1. made by payse on ntts.had bill or bill.)
Amount verified; correct for ___________
=
Per
Contract No.
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
t Approved for $ -----------------------------------
SIGN
t ------------------- -------- ---------------------------------
(Authorized Certifying Officer)
By ------------------------------------- -----------------------
Title ----------------------------------------------------------
ORIGINAL
ONLY
Title - --------------------------------------------------------------
Check No- ________________________ dited ------------------------------ 19-----,for $-------------------------------------- ton Treasurer of the United States in favor of
Paid by `payee named above.
{ Cash, $----------------------- on -- ---------------------------------, 19-----. Payee -------------------------------------------------------------------------
(elrn original only)
qr,~,q tp me pe
.When a voucher is sJ~ngdr r cei ted in e nar off company
writing the companyo>idpdUe Oe ref nr9 b[Eidcl~tld ~ /a' ar; q
"John Doe Company, pe John meth, ocrrtary ', or ' reasurer , as t e case maybe.
t If the ability to certify and authority to approve are combined In one person, one signature only is nec-
essary; otherwise the approving officer will sign on the line below "Approved for $___________________", and
over his official title.
f 4-0036 0 R00O6OOOt0145 -5-------------
Title --.-----------------------------------------------------
it--22900-6
 Stan(laard. Form NO. 1Ud6a-Rev1ses ey
Fartill per }Ao1res ,Mved For RG'~ ~se~10~A 1'~'Pr 1 OR0006(~Q~.~n~~[ y~
Compps
DU1Vi
B eptember 1
(Qen. Reg.g. No No. . 51, Supp.
No. 11) Services Other Than 1"er-0~son
CONTINUATION SHEET
No. ----! ______ of Bureau Voucher No. _20---------
Shed ,U. S. ST_ REIMBiJFiS BCE
(Department, bureau, or establishment)
ARTICLES OR SERVICES
supply schedule,
(Enter descrnpt an other information deemed necessary)
Direct Costs Properly Chargeable to
Contract a-40( for the period
1/1 thru 1/26/58
Labor for the period 1/1 thru 1/26/58
Overhead for Control Systems Division
computed at interim rate of
Other Costs
Total Labor, Overhead and Other Costs
G & A expense computed at interim
rate of