PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

Document Type: 
Collection: 
Document Number (FOIA) /ESDN (CREST): 
CIA-RDP64-00360R000600020031-0
Release Decision: 
RIPPUB
Original Classification: 
K
Document Page Count: 
2
Document Creation Date: 
December 12, 2016
Document Release Date: 
May 14, 2002
Sequence Number: 
31
Case Number: 
Publication Date: 
July 18, 1958
Content Type: 
FORM
File: 
AttachmentSize
PDF icon CIA-RDP64-00360R000600020031-0.pdf71.34 KB
Body: 
Form prescribed U Comptroller Genera], , U. B. Approved r Tl~7eA5~ P ~ 1960 b 7 er , l. No. No. SERVICES OTHER THAN P . No. 61, Supp. 11) (Gen. Reg (Amended February 20, 1952) OVAL au you: No. G--~-h-(------------------ - RE10URSAB --- ------------------------------------------ U. S. ----- COST-- --------------------------------- - ------------ ------------------------ (Department, bureau, or establishment) Voucher prepared at ------------------------------------------------------------------- (Give place and date) THE UNITED STATES, Dr., Payee's Account No. ---------------- TO -------------------------- ------------------------------------------- ------------------------------------------------------------ (Payee) -City) (----- -----------?---------------------------------- -------------------------- (State) (Address) ARTICLES OR SERVICES item number of contract or Federal supply ti i d E UNIT PRICE AMOUNT No. and Date of Order Date of Delivery or Service on escr p nter ( sedule, anal other information deemed necessary) ch QUANTITY Cost Per Dollars eta. Discount Terms Cost (2,769 .91 PAYMENT: Complete F1 Partial F1 Final F-1 Use continuation sheet(s) if necessary Shipped from to Weight Government I certify that the above bill is correct and just and that payment has not been received. TATOTHR B/L No, Total (Payee must NOT use this space) Differences --------------------------------- (2,76 9 --------------- .91 ----- (Sign original only) -------------------------------- -------------- --------------- ------ Date _ -74 8 8 * te not required when alike oertlFlanle I. medo by reyea on aetnohed biLL oe bill.) an ------------------------------- Per Title ----------------------------------------------- c. , Amount verified; correct for ___________ (Signature or --------------- ----- -- _ No. ~`p d Date Req. No_ Date Invoice Recd. Pursuant to authority vested in me, I certify that this account is correct and proper for payment. fi ------------------------------------------------------------------------------- f Approved for $____________________________________ (Authorized Certifying Gilcer) SIGN ORIGINAL ONLY Title ---------------------------------------------------------- Date ---------------------------------------- ;i-------------------------------- THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM ACCOUNTING CLASSIFICATION (Appropriation Symbol must be shown; other classification optional) Check No. _____________________dated ? 19 ? for $ pa _______________________________ on Treasurer of the United States in favor of yee named above. Paid by jl Cash, $ , on ------------------------------------? 19 Payee (Bien ori?inei an y) -------------------------- When a voucher is signed or re ipted in gt~heQqn~~ of a ~c~om~ any~opr}icto~r oration., the name of the person ~S!~ writing the company or corpoate --h 'bA'1iS e1 AIRM 4eS0OJVUR000600020031-0 "John Doe Company, per john $mi h, eeretary', or roasuror , t a, e. rlt 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 1e-22000-e over his official title. STATOTHR Approved For Release 2002/06/10 : CIA-RDP64-00360R000600020031-0 Approved For Release 2002/06/10 : CIA-RDP64-00360R000600020031-0