PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600020107-6
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 12, 2016
• Document Release Date: May 14, 2002
• Sequence Number: 107
• Publication Date: May 21, 1958
• Content Type: FORM

Page I of 2
No. and Date of
Order
Date of Delivery
or Service
ARTICLES OR SERVICES
(Enter description Item
number of contract or Federal supply
schedule,
e, and other information deemed necess
r
)
UNIT PRICE
AMOUNT
a
y
Discount Terms INVOICE ir0
Cost
Per
Dollars
Cts.
2083
2081
2085
2086
2087
2088
PAYMENT:
2089
Complete ^
2090
Partial ^
2091
Final ^
Use continuation sheet(s) if necessary
con
inued
on
STATOTHR
Standard Form No. 1034-Revised (~ o
Pptro proscribed
roved For r' *f1Ar.U{1F im ~,j~.~p {~p,Gd_~S AK
Comptroller er Gencra General, AppY1701'.l'ICIC VI( ~r vA~(,~~
(Gen. Regg. No No. 61, i upp. No. 11)
September 7 1960 ;Si VICES OTHER THAN PERSONAL
(Amended February 20, 1962) F
U. S.
-.r
-----------------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at -------------------------------------------------------------------------------------
-----------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No. ----------------
To ----------------------------------------------------------Ra- -- -m- o----- - W-- 6- -
-- e--CorP-oration
--
--
(Payee)
-------------------------------------- ------------------------------ Lou Aizgeles ~+>--California------------
Approved For Release 2002/06/10 : CIA-RDP64-00360R000600020107-6
 Stancl[trd. Foam No. 1034-Revised
Form prescribed by o~Tg~,
Comptroller General, U. S. QpproveJJ~l i 1xQR
September 7, 141p. No. 11) MRVICES 0TH
(G(AmenReg. No. 51, ded February 20,1952)
U. U.S. -------------------------------------------------------------------------------------------------------------------------------
(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
PAYMENT:
Complete ^
Partial ^
Final ^
Date of Delivery
or Service
NN~~ D. O. Vou. No. ---Rt--------------------------
'N%O 8000600020107-6
I certify that the above bill is correct and just and that payment has not been received.
Dollars Cts.
STATOTHR
--------------- -----
--------------- -----
----------------------
Date -------------------- *Payee --------------------------------------------------------------- -------- ) -- ----- -------------------------------------- --------------- -----
Amount verified; correct for ___-_------
Per -------------------------------------------- Title ---------------------------------------------- (Signature or initials) ft'-------------------------------STATOTHR
Contract No. A-101 Date Req. No. Date Invoice Recd:
Pursuant to authority vested in me, I certify that this account is correct and proper for pal
t Approved for $ -----------------------------------
By --
Title
SIGN
ORIGINAL
ONLY
Contracti Officer}
H EV RM MUST BE EXECU WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
Check No- ------------------------ dated -----------------------------, 19 ------ for $-------------------------------------- on Treasurer of the United States in
Paid by I Cash, $ , on 19 Payee . - favor of - payee -
- named - above.---------
----------------------------
(8150 orielnnl only)
? When a voucher is signed or recei ed in the no pt a co p~a~y or corp p1 j'Q of ljer r~~r
writing the company or corporate na4 @QodporYti4~'Ie~I8i4611Y*M't F~I;4=0-0-3~GROIDID6-0100-ZO" 1.0'1=6
"John Doe Company, per John Smith, S cretary", or "Treasurer", as the case may c.
t If the ability to certify and authority to approve are combined in one person, one signature only is nee- Title ------------------------------- "_"" """?
essary; otherwise the approving officer will sign on the line below "Approved for $---------------------, and
10-22900-8
over his officio] title.
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
schedule, and' other information deemed necessary)
Discount Terms INVOICE NO.
2092
2093
209+
2095
2096
2097
2098
2d99