PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600020090-5
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: December 12, 2016
• Document Release Date: May 14, 2002
• Sequence Number: 90
• Publication Date: June 10, 1958
• Content Type: FORM

Standard Form No. 103t-Revised
Form prescri)Jed by
Comptroller General, U. S.
September 7, 1000 Approved No. (G(Amenen. February 0 10No.
EV R 0 S RM MUST BE EXEC ED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
U. U.S. -------------------------------------------------------------------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at --------------------------- ----------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No_ ----------------
TO --------------------------------------------------------- amo-Wooldridge--Corporation
----------------------- -------------------
(Payee)
------------------------------------------------------------------- Los Angeles5~- California
----------------
(Address) (City) (State)
No. and Date of
Date of Delivery
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
QUANTITY
Q
UNIT PRICE
AMOUNT
Order
or Service
- schedule, anti other information deemed necessary)
Discount Terms INVOICE NO s
Cost
Per
Dollars
Cts.
2105
12
o
2106
28,198
2107
2,763
55
2108
19,475
79
2109
l0
6
2110
1,197
8
PAYMENT:
Complete F-1
Partial ^
Final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government B/L No.
Total
61i., 52'-F
I certify that the above bill is correct and just and that payment has not been received.
(Payee must NOT use this space)
_
Differences ---------------------------------
---------------
-----
(Sign original only)
-------------------------------------?-----?-
---------------
Date -------------------- *Payee -------------------------------------------------------------------------
----------------------------------------------
-
----------- --
-----
(This oertifloat, not,equired when alike certificate Is made by payee on attached bill or bill.)
Amount verified; correct for __________
_
&
0
MUGM& 1~P~CPpC
P1~'41 6 000600020090-5
~
VICE HER THAN PERSONAL Bu. Vou. No. ____-____________________________
Page 1 of 1
t Approved for $ --=--------------------------------
STATOTHR
By _r
Title
Check No- ________________________ dated ------------------------------ 19_____, for $-------------------------------------- on Treasurer of the United States in
Paid by { favor of payee named above.
Cash, $------------------------- on ----------------------------- -------- 19-----. Payee ------------------------------- -----------------------------------------
(sign .,10-1 only)
When a voucher is signed or receip din the Dam o co an or cor o t 1Q 9,of t}J@.p~rs per,,
writing the company or corporate m ,a $ ~tty tJFbt(~? g }'p { *36 Q'R{ {~Q6{}