PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL
Document Type:
Collection:
Document Number (FOIA) /ESDN (CREST):
CIA-RDP64-00360R000600020115-7
Release Decision:
RIPPUB
Original Classification:
K
Document Page Count:
3
Document Creation Date:
December 12, 2016
Document Release Date:
May 14, 2002
Sequence Number:
115
Case Number:
Publication Date:
April 25, 1958
Content Type:
FORM
File:
Attachment | Size |
---|---|
![]() | 113.76 KB |
Body:
i3tanciurd l urln No? 1034-Revised
Form prescribed by NARI
Comptroller Cierlerd, U?S?
Approved September 7;,1!'I~0
(Gen. Reg. 1110. bl, Stipp. No. 11)
(Amended February 20, 1952)
D. O. Vou. No. ------------------------------
11
Ati -r-%5v 1
Bu. Vou. No- ---------------------------------
U. S. ----- COST--REIMBURSABLE
--------------------------- -
(Department, -----------------------------------------------------------
bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No. ----------------
TO -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
UNIT PRICE
AMOUNT
No. and Date of
Order
Date of Delivery
or Service
schedule, and other information deemed necessary)
QUANTITY
Cost
Per
Dollars
Cts.
Discount Terms
Cost
4,939
.07
PAYMENT:
Complete ^
Partial ^
Final ^ Use continuation sheet(s) if necessary
-
Shipped from - to Weight Government B/L No. Total
, 939
.
U7
(Payee must NOT use this space)
I certify that the above bill is correct and just and that payment has not been received.
Differences ---------------------------------
---------------
-----
STATOTH R (Sign original only)
/ ------------- ---------------------
-------------------
Dste --R55 Payee --- --- ----------------- --=-------------------
otr equired whop alike oerti6aate 1. made by payee on attaohed bill or bill.)
_____
Amount verified; correct f
-----------
-----------
;
--
~
Per Title ---------------------------- -- -------------- (Signature or initials) -------------------
---------
------
------
Contract No. - 1! Date Req_No. Date Invoice Rec d.
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
SIGN
ORIGINAL
ONLY
-------- --------- --------
-----------------------
(Authorised Certifying Officer)
Title ---------------------------------------------------------- Date --------------------------------------------------------------------------
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
( Check No. --------- 1payee dated _____________________________, 19 ----$i_______ on Treasurer of the United States in favor of
Paid by payee named above.
Cash. $------------------------ on ------------------------------------- 19 ------ Payee -----------------------------(61rn-------origi---nal----only) -----------------------------
-When a voucher is signed or recoipted in the name of a company or corporation, the name of the person Per _________________________________________
writing the company or corporate n e 1 o a
Tohn Doe Company, per John s> 64-003608000600020115-7
tIf the ability to certify and authority to approve are combined in one person, one signature only is nec- Title __________________________________________________
otherwise the approving officer will sign on the line below "Approved for $------------------- '-, and
1e-22900-6
oasaly;
over his official title,
Approved For Release 2002/06/10 : CIA-RDP64-0036OR000600020115-7
Approved For Release 2002/06/10 : CIA-RDP64-0036OR000600020115-7
FORM STL - 660
Approve or e e 20"/16 CIA DP6 Ofr36-1R 7
ACCOUNTS PAYABLE WEEKLY DET DISTR
BATCH
No. Mo. Day Yr.
INVOICE
NUMBER
PURCHASE
ORDER
CHECK
NUMBER
PAYMENT
DATE
Mo. Day
Vendor
Number
GROSS
AMOUNT
DISCOUNT
n n
E U
r m
o $
Uw
w
Pi A
E. U
COST CENTER
Maj. Int. Sub.
CHARGE DISTRIBUTION
Account M.J.O. S.D. Work Order
NET AMOUNT
20
04
14
8
24741
F
015
43560
05
09
1823
50
25
27
20
1.2501
5046
01
1
42800
342400
342400 **
6
5
-
E-
3
2
A
ppro
ved Fo
r Release 2002/
06/10 CIA-
RD
P6
4-00
360
R000
600
020115-7