PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600020047-3
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 2
• Document Creation Date: December 12, 2016
• Document Release Date: May 14, 2002
• Sequence Number: 47
• Publication Date: July 25, 1958
• Content Type: FORM

Pi
on. Rog, No. 51, Supp. No. 11) SERVICES OTHER THAN PERSOr B
V
N
corm ytcourx~ou "y
Comptroller (}eneral; U. S. )
ion*~ , or, 19% Approve PAC-Nffib' - OR000600020047-3
u.
ou.
o - ------
-
(Amended 1`eurunty zu, t5U'/
U. U.S. ------ COST-RETOTJRSABLE-----------------------------
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No_ ----------------
TO ----------- --------------------------------------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (State)
No. and Date of
Order
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
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government B/L No. Total
I: certify, that the above bill is correct and just.and that payment has not been received. . I (Payee must NOT use this space)
STATOTHR
Date _-- ?51 ~ 8 --- s Pavee ---------------------------------------------------I ----------------------
to not required when n Ilk. oertiaoate 1. made by pnyea on attaohed billor bill.)
Contract No. 77-70 j Date Req. No.
t Approved for $ -----------------------------------
By ------------------------------------------------------------
Title ----------------------------------------------------------
SIGN
ORIGINAL
ONLY
2
----------------------------------------------- ---------------
-------- --------- ------- -
Amount verified; correct for
(Signature or initials) -_------------------------__.
Date Invoice Recd.
t ----------------------------------------------------------------
(Authorized Certifying Officer)
Title --------------------------------------------------------------------..-.
e-~
Check No_ ------------------------ dated ------------------------------ 19 ------ for $-------------------------------------- jon Treasurer of the United States in favor of
Paid by {payee named above.
-- - -----------------------
---- -----
Cash. $ --------? + on - ------- - 19 Payee -
(Big. original only)
? When a voucher is signed or recei ted in the na a of a_cqr~ ny or corpppp~~gg p e feye~pe
writing the company or corporate naQtlftti$@s~jt9)~i F(tyE~Ldn~BJ f}f}3fiflRflflfl6flfl02fl04~-3 ----
----------------
"John Doe Company, per John Smith, ecretary", or "Treasurer", as the case may be.
tIf the ability to certify and authority to approve are combined in one person, one signature only is noo- Title ___________________
essa otherwise the approving officer will sign on the line below "Approved for $______-____________", and -------------------------?------over his official title.
i0-22900-6
8326
 STATOTHR
` Approved For Release 2002/06/10 : CIA-RDP64-00360R000600020047-3
Approved For Release 2002/06/10 : CIA-RDP64-00360R000600020047-3