PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600020132-8
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 12, 2016
• Document Release Date: May 14, 2002
• Sequence Number: 132
• Publication Date: December 6, 1957
• Content Type: FORM

`Sltamdf,' 4'1 Foifl1 No. 1034-Revised D. O. Vou. No_ _______________________________
~04al prescrfbed by - - - - - -tt~ _ _ 7[?_ II M TruA:a aw/an xi mr.Ju'S. Awr -------------- -- -
Qomptfoller General, U. S.
! SeptAber 7, 1950
VGon. Reg. No. 51, STIPP. No-.-I
U. S. ----COST _REIMBURSABLE-----------------------------------------------------------------------------------------
(hpartmena, bureau, or establishment)
Voucher prepared at ----------------- -----------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No_ ----------------
TO -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
-----------------------..---------------------------------------------------------------------------------------------- -----------------
(Address) (City) (State)
GNe.& I
SAPC 15,099 01~
L COPY / OF Z
t
f
N
d D
te
f Deliver
D
ARTICLES OR SERVICES
item number of contract or Federal supply
(Enter description
UNIT PRICE
AMOUNT
e o
o. an
a
Order
y
o
a
or Service
i
schedule, and other information deemed necessary)
Discount Terma
QUANTITY
Cost
Per
Dollars
Cts.
Cost
415
58
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government B/L No.
Total
-- l?1
5
I certify that t ,e above bill is correct and just and that payment has not been received.
(Payee must NOT use this space)
Differences ---------------------------------
---------------
-----
STATOTH R (Sign original only)
Date __12
to net required wLen e. line -611-t, I. made by Payee on att.ehod bill., buin)
_
Amount verified; correct for
---------------
-----
__
________
Per
-------- Title
(Signature or initials) --------- ________
________________
______
Contract No. A101 Date Rcq. No.
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
t Approved for $-----------------------------------
By ------------------------------------- -----------------------
Title ----------------------------------------------------------
SIGN
ORIGINAL
ONLY
Date Invoice Rec'd.
------------------------------------------------------------------------------
(Authorized Certifying Officer)
Title ----------------------------------------------------------------
Date -------------------------------------------------------------------------
(Check No. ________________________ dated ------------------------------ 19_____, for $...................................... Jon Treasurer of the United States in favor of
yard by
Cash, $------------------------- on ------------------------------------? 19 Payee -------------------------------------------------------------------------
(8ien orieinal only)
" When a voucher is signed or rectag he na p4 a compay or corp yQ y~}Q of er
writing the company or corporate pant(~d?~15@1EyRA@t~E~itil~9it/ ote
"
"
"
, as the case may be.
, or
Treasurer
"John Doe Company, per John Smith, Secretary
t If the ability to certify and authority to approve are combined in one person, one signature only Is nec-
essary; otherwise. the approving officer will sign on the line below "Approved for $_________________-_ , and
over his official title.
f~64 f}E}3&OROOOS)OO2Ot3't-8----------------------
Title -------------------------------------------------------
 Approved For Release 2002/06/10 : CIA-RDP64-0036OR000600020132-8
Approved For Release 2002/06/10 : CIA-RDP64-0036OR000600020132-8