PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600020082-4
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 12, 2016
• Document Release Date: May 14, 2002
• Sequence Number: 82
• Publication Date: June 23, 1958
• Content Type: FORM

Form pprescribed b ~VV7\(A1l
Cor~aptroller General, rv, s. Approved V $,ee fi
p
September 7, 1950
RVICE
0
1)
9. 1
k0.
February 20, 952)
ARTICLES OR SERVICES
(Enter descriptiont item number of contract or Federal supply
schedule, and other information deemed necessary)
Discount Terms
U. S. __ COST REIMBURSABLE -
- ----------------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at place -an- date)
THE UNITED STATES, Dr., Payee's Account No. __-____________-
- ------------------------------------------------------------
----------
d (Payee)
----?
--------------------------------itv1 ------- (State)
r(7
No. and Date of
Order
Date of Delivery
or Service
PAYMENT:
Complete ^
Partial ^
Final ^
02000#00820
Bu. ou. o. -
Use continuation sheet(s) if necessary
n n c t, Total
I certify that the above bill is correct and just and that payment has not been received,
Date 6L?3 58
Date Req. No.
Contract No.
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
f Approved for $ -----------------------------------
SIGN
ORIGINAL
ONLY
must NOT use this space)
11737
--------------
---------------
---------------
------------ ----
Amount verified; correct for -__-__-__-_7 /Z 31 -
(Signature or initials) _'J---------------------------------
Date Invoice Recd.
-- - --------- - ---------
I (Authorized Certifying Officer)
Title ---------------------------------------------------------------------------
------------------------
Date ----------------------------------------------
- ------ -------
Title 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)
----__ _____ on Treasurer of the ilnited States in favor of
Check No. ------------------------ dated -----------------------------, 19-----,for $------------------------- {payee named above.
------------
_____________________________ y)
Paid by 19 _____? Payee ----------------
i91
Cash, $------------------------+ on _------- gn original onl
When a voucher is signed or eeoipted in the name of a company or corporation, the name of ~thaegppeerslon Per
R000600020082-4
writing the company or corpora a 44pQaC I/yr11LJF'6 -0036,0
"John Doe Company, por John o it yr ecre ar o
nd
j If the ability to certify and authority to approve are combined in one person, one signature only is DOC- ---------------------------------
1c-22000-6
essary; otherwise the approving officer will sign on the line below "Approved for $___________________", and
over his oflicial title.
 STATOTHR
Approved For Release 2002/06/10 : CIA-RDP64-00360R000600020082-4
Approved For Release 2002/06/10 : CIA-RDP64-00360R000600020082-4