PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• 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
• Publication Date: July 18, 1958
• Content Type: FORM

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