PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600020099-6
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: December 12, 2016
• Document Release Date: May 14, 2002
• Sequence Number: 99
• Publication Date: May 22, 1958
• Content Type: FORM

? 5tt~ndnrd Form No. 1034-Revised
Form proscribed by /
Comptroller Cleneral U 8. ~ roved f't5~~~~~
September 7, ),9~? pp ~
(Qen. Reg. N~. 61,'Supp. rTo _ll)
pp D. O. Vou. No. ---------?---------?---?----
~36100600020099-6
Bu. Vou. No. --------------?-----------------
___ ___ --___.-- _-? - Page 1 of 1
U. S. -------------------------------------------------------------------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
((3ivo place and date)
THE UNITED STATES, Dr., Payee's Account No. ________________
To -----------------------------------------------------------Remo-Wooldr3,die__Corporation-----------------
(Payee)
------------------------------------------------------------------------ Los_ Arlgezes__?~5_x__California --------=-
(Address) (City) (State)
and Date of
No
Date of Delivery
ARTICLES OR SERVICES
(Enter description, item number of contract or Federal auppiy
NT
UNIT PRICE
AMOUNT
.
Order
or Service
schedule, and other finformation de~e~ym~erd necessary)
'
QUA
ITY
Coat
Par
Dollars
Cta.
+ ~Q y
Discount Terms .t.y~ y ~I{~,,L
2100
59
2101
25,815
8g
2102
366
76
2103
22,363
38
210+
600
09
PAYMR3NT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government B/L No.
Total
~_
(Payee must NAT use this space)
I certify that the above bill is correct and just and that payment has not been received.
Differences ---------------------------------
---------------
-----
(Sign original only)
Date -------------------- * Payee --------------------------------------------------------------------------
(Thie oerti9rato not required when a like aerttflasta i~ made by oarea on nttaohgd biLL or b111e)
----------------------------------------- ---
-
Amount verified; correct for ___________
- -------------
~'%~ ~'~
-----
~`
t APProved for $ -----------------------------------
STATOTHR
f
SIGN
ORIGINAL
ONLY
_~ J,
SaTATOTHR
(Contracting Off er)
Date --------------------------------------------------------------------------
Q pr
Approyf ERS SFO MUST BE EXEC TED WHEN PURCHASES ARE MADE OR SERYICES S@CURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
( Check No. ________________________dated _____________________________, 19_____, for $______________________________________ f on Treasurer of the United States in
Paid by jl l favor of payee named above.
Cash, $------------------------~ on ------------------------------------' 19-----. Payee ------------------------------------------------------------------------
(618? ori?inal only)
Z
(Signature or initials) _________________________________
/'
~
/
' When a voucher is signed or recoi tcd in the na o a co~Pa~y or cord r t o 0 of a ______
writing the company or corporate naxi~$ l~~c 1~~e;ii ~~ ,~ 6r4=flfl~6flf2000600020099=8 -----------------
"Jahn Do? Company, for John 6mith, S ct; rotary", or "Treasurer' , as the case may e.
tIf the ability to certify and authority to approve are combined in ono person, ono signature only ie noo- Title _________________________________________________
essar ,otherwise the approving officer will sign on the line below "Approved for $______.__ ", and __-"'
y 1e-22909-6
over his official title.