PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600010169-9
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 4
• Document Creation Date: November 17, 2016
• Document Release Date: July 29, 1999
• Sequence Number: 169
• Publication Date: February 10, 1958
• Content Type: FORM

kltandard Form No. 1934-Revised
Fatm prescribed by
Comptroller Ciencral, U, 8. Y,
~: 8optemYer~tt9~~~~~d For F~~~IC~~
(Qen. Redg. No. 61,
(Amen ed'Febnwry 0, 1952)
~~~~~TI~TQ'~E1~~DN~~60R00060001 ~a~69-9______..--__-
- -------------------------------------------------------------------
(Department, bureen, or establishment)
Voucher ~re~ared af --------------------------------------------------------------------------
(give place and date)
THE UNITF,D STATES, Dr., Payce's Accourlf No. ________
To
------------------------------------------------------------------------------------------------
(Payoe)
--sAPCo~54~s~
COPY / OF
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (9tato)
No. and Dake of
Order
Date of Delivery
or Service
ARTICLES OR SERVICES
(Enter description Item number of contract or Federal supply
schedule
an~ other inf
r
ti
d
d
QUANTITY
UNIT PRICE
AMOUNT
,
o
ma
on
eeme
necessary)
Discount Terms
Cost
Per
Dollars
Cts.
cost
10,50$
2~-
PAYMENT:
Complete ^
Paxtial ^
Final ^
Uae continuation sheet(s) if necessary
Shipped from to Weight Government
B/L No. Total
].,~ 508
2~+
I certify that the above bill is correct and just and that payment has not been received.
(Payee must NOT use this space)
I
STATI NTL (Sign original only)
Differences ---------------------------------
---------------
-:---
Date _~ _?~4 -~8----- *Payee -------------------------------------------------------------------
-----
------
-
-
--
--
reQU red when s lilts certifionte i. made b~ Dnyee on ekhahed 6111 or b31L)
----------
---
---
---------------------
_` - -
Amount verified; correct for(_
---- ------- ---
~~y ~d `
-----
~ ,r
Per --- --- Title ----------------------------------------------
Contract No. A -i D j Date Req. No. Uate In efts ec'd.
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
~' APProved for $ ?----?----------------------------
Title ----------------------------------------?----------------
SIGN
ORIGINAL
ONLY
t -------------------------------------------------------------------------?----
(AUthorized Certifying Officer)
Title -----------------------------------------------------------------------....._
Date -----------------------_-------------------------------------------------
THE REVERSE OF THIS FORM MUST BE ESECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT 1N ANY FORM
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be shown; other clsaslfication optional)
Check Nn. ________________________dated _______________________-_____, 19_____,for $______________________________________ on Treasurer of the United State?in favor of
Paid by ~ {payee named above.
Cash, $------------------------? on -----------?-----------------------' 19-----. Payee --------------------------------------------
- (91?n nri?innl ody)
..,,m. u vouonrr xs slgueu or recelprea) c nam a Qompauy or o i tt~~ o of m?
writing the company orc/~~pp{{~ ~~~~ o C~4?}?p~~~~y~~~~ .F~~
"
`l
~
john Doo Company, pPr
aCL
tE, oar , o a u r , as o case may c.
} If the ability to certify and authority to approve arc combined in ono person, ono signature only is nec-
essary; otherwise the approving officer will sign on the line below "Annroved for ~_______________ "_ anA
~~=00~3fiflR000~0{~1~}'I~9-s---------_~
Title _______________._______________________
 corm ptescrtbed b *~
c?m~e~tg~ e ' e ~0~b~n ~
~~Oa36~bR000600010169-9
~~
died For F~e
le
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(G#en. Reg.:Qo. sI, 8 pp. No. 11) e~~l~eRC~S ()~he~ 'Than ~~I"S0I4t~~ 1Vg~~I?ffZt~1~~~J
CCIVB'IP+ILJATION SHEET
U. S. ___~QS~._.R~.I~t1_R~~T,t~-------------------------------- Sheet IVo. 1 --_ of &ureau V?ttcher 1Va. 2026
(Department, bureau, or establishment) -------?----
Date of
Delivery
or Service
ARTICLES OR SERVICES
(l?nter description, Item number of contract or Fedoral suppPy schedule,
and other information deemed necessary)
Contract `Jo Costs applicable
to All Systems
Direct Costs Properly Chargeable to
Contract ~ for the period l~l
thru 2~2
STATINTL
STATINTL Research &
Development
Labor fothe per.~od 1~1 thru 2~2~58
JV Ol 07
Overhead computed for Communications
Division at inter m rates as follows:
Rese ch & Dev lopment - -
Other Cots - Per schedule attached
Total La~or, Over~.ead and Other Costs
G & A ense com uted at interim
rate of
Total Cots
STATINTL
Q aT~~
$ lo, 508
U. 8. GOVEFNME r P !fJ i OF ICe lE
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