PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600010165-3
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 17, 2016
• Document Release Date: July 29, 1999
• Sequence Number: 165
• Publication Date: February 10, 1958
• Content Type: FORM

Eitandmdrotn No. 1084-Revised - D. O. Vou.No.____________________________
Comptroller (]
Formpro'c die d For- SERVICE
" J9M%ftJ#36ORO006OOO19J?5-3
2be 7,
(Gen. Reg.'eNom . 61, SuPP+ No. 11) Bu. Vou. No. ---------------------------------
(Amended February 20, oeoj
U. S. _---COST-- REIMBURSABLE ----- ----------------- -----------------------__________________________________________
----------------------------------
(Department, bureau, or establishment)
Voucher prepared -at ------------------------------------------ 4
THE UNITED STATES, Dr., Payee's Account No- ------------
To ----------------------------------------------------------------------------------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (State)
No. and Date of
Order
PAYMENT:
Complete ^
Partial ^
Final ^
Date of Delivery
or Service
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
schedule, and other information deemed necessary)
Discount Terms
Use continuation sheet(s) if necessary I I
to Weight Government B/L No. Total
I certify that the above bill is correct and just and that payment'has not been received.
STATINTL
~..a(5 *Payee --------------
Date .t. not required when a Illre-eertifieete ie mxde by parse Boa isaetied bin oe bS W
Per-
Contract No. - I 0 f
(Payee must NOT use this space)
Differences --------------------------------
6,310.
5t+
6,310.
Amount verified; correct for __._-t_1---I / C 't s
Title -__ ------------------------------------------ s rtatttre or mttrais
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
By ---------------------------------- ------------------------
SIGN
ORIGINAL
ONLY
t ------------------------ - - ------ ---------------------------
(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
I Check No. ------------------------ dated _____________________________, 19 -----,for $__-______________..................... on Treasurer of the United States in favor of
Paid by payee named above.
Cash, $ ------ on ---------------- -------------------- 19------ Payee ---------------------------- -----------------------------
(Sinn orlainei only)
e When a voucher ho
writing the compan?a~Cg~ i Jrr~ii d c t9~llas L AR~SIV]GRf 46V/ ,511/r r peaf,rCb1-e l-/l'
"John Doe Company, per John Smith, Secretary", or "Treasurer", as the case may be.
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.
4=003-6-0Rt OU60001-01-65=3--------------
Title -----------------------------------------------------
 Sttuida*rd Form No. 1035a-Revised
Form res6rid & ,roved FotPR;IU?SW
ComBtr to (le qQJQ~kWfIU
'~~?~ 4 ' :~G ~ Me-FO 360R000
(Gun. Rei. No. 51, Sapp. No. 11) Nervices Other Than Persona
CONTINUATION SHEET
U. S. COST REIMBURSABLE - Sheet No. ----- 1-_-_ of Bureau Voucher No. __ 022
----------------- --------------------- ------- --- -----------------------
and Date
of Order
Date of
Delivery
or Service
ARTICLES OR SERVICES
(Enter $escrlpt ana Item
other information deemed necessary) number of contract or Federal supply schedulep
Contract y -to ( System III
Direct Costs Properly Chargeable to
Contract A-to for the period 1/1
thru 2/2 5
STATINTL
Research &
Development
Labor fo the per
JV 010007
Overhead computed
Division at inter
Rese ch & De
Production -1
Total La$or and 0
G & A ex ense com
rate of
Total Cots
od 1/1 thru 2/2/58
TATINTL STATINTL
for Communications
m rates as follows:
relo-oment --
STATINTL
Y NY PIT OFP E -1 665-3
Approved For Release ~bUdffXf~"G IIAp6-Rb''64-00360R000600010165-3