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: 
AttachmentSize
PDF icon CIA-RDP64-00360R000600020115-7.pdf113.76 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